Division of Plastic and Reconstructive Surgery McGill University Health Center, Montreal, Canada.
Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
Ann Surg. 2022 Feb 1;275(2):e315-e323. doi: 10.1097/SLA.0000000000005057.
The objectives of this study are to assess the efficacy and safety of peripheral nerve surgery for migraine headaches and to bibliometrically analyze all anatomical studies relevant to migraine surgery.
Migraines rank as the second leading cause of disability worldwide. Despite the availability of conservative management options, individuals suffer from refractive migraines which are associated with poor quality of life. Migraine surgery, defined as the peripheral nerve decompression/trigger site deactivation, is a relatively novel treatment strategy for refractory migraines.
EMBASE and the National Library of Medicine (PubMed) were systematically searched for relevant articles according to the PRISMA guidelines. Data was extracted from studies which met the inclusion criteria. Pooled analyses were performed to assess complication rates. Meta-analyses were run using the random effects model for overall effects and within subgroup fixed-effect models were used.
A total of 68 studies (38 clinical, 30 anatomical) were included in this review. There was a significant overall reduction in migraine intensity (P < 0.001, SE = 0.22, I2 = 97.9), frequency (P < 0.001, SE = 0.17, I2 = 97.7), duration (P < 0.001, SE = 0.15, I2 = 97), and migraine headache index (MHI, P < 0.001, SE = 0.19, I2 = 97.2) at follow-up. A total of 35 studies reported on migraine improvement (range: 68.3%-100% of participants) and migraine elimination (range: 8.3%-86.5% of participants). 32.1% of participants in the clinical studies reported complications for which the most commonly reported complications being paresthesia and numbness, which was mostly transient, (12.11%) and itching (4.89%).
This study demonstrates improved migraine outcomes and an overall decrease in MHI as well as strong evidence for the safety profile and complication rate of migraine surgery.
本研究旨在评估外周神经手术治疗偏头痛的疗效和安全性，并对所有与偏头痛手术相关的解剖学研究进行文献计量学分析。
偏头痛是全球第二大致残原因。尽管有多种保守治疗选择，但仍有患者患有反射性偏头痛，这会导致生活质量下降。偏头痛手术定义为外周神经减压/触发点失活，是一种治疗难治性偏头痛的相对较新的治疗策略。
根据 PRISMA 指南，系统地在 EMBASE 和美国国家医学图书馆（PubMed）中搜索相关文章。从符合纳入标准的研究中提取数据。进行汇总分析以评估并发症发生率。使用随机效应模型进行总体效果的荟萃分析，并使用固定效应模型进行亚组内分析。
本综述共纳入 68 项研究（38 项临床研究，30 项解剖学研究）。随访时，偏头痛强度（P < 0.001，SE = 0.22，I2 = 97.9）、频率（P < 0.001，SE = 0.17，I2 = 97.7）、持续时间（P < 0.001，SE = 0.15，I2 = 97）和偏头痛头痛指数（MHI，P < 0.001，SE = 0.19，I2 = 97.2）均有显著降低。共有 35 项研究报告了偏头痛改善（范围：68.3%-100%的参与者）和偏头痛消除（范围：8.3%-86.5%的参与者）。临床研究中有 32.1%的参与者报告了并发症，最常见的并发症为感觉异常和麻木，多为一过性（12.11%）和瘙痒（4.89%）。
本研究表明，偏头痛手术治疗偏头痛的效果有所改善，偏头痛头痛指数总体降低，并且安全性和并发症发生率方面也有强有力的证据支持。
