Raposio Edoardo, Raposio Giorgio, Baldelli Ilaria, Peled Ziv
From the Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genova, Italy.
Plastic and Reconstructive Surgery Division, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Plast Reconstr Surg Glob Open. 2024 May 1;12(5):e5784. doi: 10.1097/GOX.0000000000005784. eCollection 2024 May.
Modern surgical therapy of chronic headaches/migraines is essentially based on the release/neurolysis of extracranial nerves, which, when compressed or inflamed, act as trigger points and, as such, trigger headache attacks. The aim of this article was to describe a novel maneuver we use as an aid in the preoperative planning of occipital trigger sites.
In the period of January 2021-September 2023, we operated on 32 patients (11 men, 21 women, age range: 26-68 years), who underwent migraine surgery for occipital trigger point release. All patients were evaluated using the described preoperative maneuver. In a dedicated card, the levels of tenderness at each point were marked accordingly, differentiating them by intensity as nothing (-), mild (+), medium (++), or high (+++). Patients were then operated on at the points corresponding only to the ++ and +++ signs.
At 6-month follow-up, we observed significant improvement (>50%) in 29 patients (91%), with complete recovery in 25 patients (78%).
In our experience, the maneuver described, in addition to being very simple, has been shown to have good sensitivity and reproducibility. We therefore recommend its use, especially for those surgeons beginning their practice in this particular area of plastic surgery.
慢性头痛/偏头痛的现代外科治疗主要基于颅外神经的松解/神经lysis，当这些神经受到压迫或发炎时，会作为触发点，进而引发头痛发作。本文的目的是描述一种我们在枕部触发点术前规划中用作辅助的新操作方法。
在2021年1月至2023年9月期间，我们对32例患者（11例男性，21例女性，年龄范围：26 - 68岁）进行了手术，这些患者因枕部触发点松解而接受偏头痛手术。所有患者均使用所描述的术前操作方法进行评估。在一张专用卡片上，相应地标记每个点的压痛程度，根据强度将其区分为无（-）、轻度（+）、中度（++）或重度（+++）。然后仅在对应++和+++体征的点上对患者进行手术。
在6个月的随访中，我们观察到29例患者（91%）有显著改善（>50%），25例患者（78%）完全康复。
根据我们的经验，所描述的操作方法除了非常简单外，还具有良好的敏感性和可重复性。因此，我们建议使用该方法，特别是对于那些刚开始在整形外科这一特定领域开展业务的外科医生。
