University Vita-Salute San Raffaele, Milan, Italy.
Surgical Medical Group, Milan, Italy.
J Headache Pain. 2021 Mar 4;22(1):9. doi: 10.1186/s10194-021-01218-6.
Idiopatic trigeminal neuralgia purely paroxysmal (ITNp) distributed in the supraorbital and suprathrochlear dermatomes (SSd), refractory to conventional treatments have been linked to the hyperactivity of the corrugator supercilii muscle (CSM). In these patients, the inactivation of the CSM via botulinum toxin type A (BTA) injections has been proven to be safe and effective in reducing migraine burden. The main limitation of BTA is the need of repetitive injections and relative high costs. Based on the study of the motor innervation of the CSM, we describe here an alternative approach to improve these type of migraines, based on a minimally invasive denervation of the CSM.
Motor innervation and feasibility of selective CSM denervation was first studied on fresh frozen cadavers. Once the technique was safely established, 15 patients were enrolled. To be considered eligible, patients had to meet the following criteria: positive response to BTA treatment, migraine disability assessment score > 24, > 15 migraine days/month, no occipital/temporal trigger points and plausible reasons to discontinue BTA treatment. Pre- and post- operative migraine headache index (MHI) were compared, and complications were classified following the Clavien-Dindo classification (CDC).
Fifteen patients (9 females and 6 males) underwent the described surgical procedure. The mean age was 41 ± 10 years. Migraine headache episodes decreased from 24 ± 4 day/month to 2 ± 2 (p < 0.001) The MHI decreased from 208 ± 35 to 10 ± 11 (p < 0.001). One patient (7%) had a grade I complication according to the CDC. No patient needed a second operative procedure.
Our findings suggest that the selective CSM denervation represents a safe and minimally invasive approach to improve ITNp distributed in the SSd associated with CSM hyperactivation.
The data collection was conducted as a retrospective quality assessment study and all procedures were performed in accordance with the ethical standards of the national research committee and the 1964 Helsinki Declaration and its later amendments.
单纯阵发性三叉神经痛（ITNp）分布在上眶和额上滑车神经皮区（SSd），对常规治疗无效，与皱眉肌（CSM）过度活跃有关。在这些患者中，通过注射肉毒杆菌毒素 A（BTA）使 CSM 失活已被证明是安全有效的，可以减轻偏头痛负担。BTA 的主要限制是需要重复注射和相对较高的成本。基于对 CSM 运动神经支配的研究，我们在这里描述了一种替代方法，通过对 CSM 进行微创去神经支配来改善此类偏头痛。
首先在新鲜冷冻尸体上研究 CSM 的运动神经支配和选择性 CSM 去神经支配的可行性。一旦该技术安全建立，就招募了 15 名患者。要符合入选标准，患者必须满足以下标准：对 BTA 治疗有反应、偏头痛残疾评估评分>24、>15 偏头痛天/月、无枕部/颞部触发点和合理的停止 BTA 治疗的理由。比较术前和术后偏头痛头痛指数（MHI），并根据 Clavien-Dindo 分类（CDC）对并发症进行分类。
15 名患者（9 名女性和 6 名男性）接受了所述手术。平均年龄为 41±10 岁。偏头痛发作次数从 24±4 天/月减少到 2±2（p<0.001），MHI 从 208±35 减少到 10±11（p<0.001）。根据 CDC，1 名患者（7%）发生 1 级并发症。无患者需要再次手术。
我们的发现表明，选择性 CSM 去神经支配是一种安全且微创的方法，可以改善分布在 SSd 并与 CSM 过度活跃相关的 ITNp。
数据收集作为回顾性质量评估研究进行，所有程序均符合国家研究委员会的伦理标准以及 1964 年赫尔辛基宣言及其后修正案。
