Novak V J
Clinica Villa im Park Rothrist, Lucerna, Svizzera.
Ital J Neurol Sci. 1995 Nov;16(8 Suppl):49-55.
The "neurovascular primary headaches" are syndromes also pertinent to otorhinolaringology when CT demonstrates a reduced volume of the "ethmoidosphenoidal subcribriform chamber" according to the endo-exocranial hemoangiokinetics of this area. It is emphasized that in drug-resistant headaches recovery or consistent definitive improvement can be achieved only after surgical correction of certain anatomical parameters (P. Bonaccorsi, V.J. Novak, S. Hoover). Bonaccorsi and Novak independently identified the actual pathophysiologic mechanism and trigger zone ("dysmorphism") for various types of neurovascular primary headaches. Patients (n = 446) with various types of headaches (migraine, cluster headache and so-called idiopathic or primary headaches) were operated upon between 1973 and 1994. Septal correction, resection of the middle and superior concha, ethmoidectomy, and sphenoidectomy on the corresponding headache side or occasionally on both sides were carried out. Most patients (356, 80%) were asymptomatic postoperatively, 45 (10%) had a sensation of pressure in the head on rare occasions but no further migraine, and 45 (10%) continued to experience headache that occurred only rarely and was mild and of short duration. The overall success rate was 90%. For cluster headache in 20 patients, we observed the following postoperative results: 19 cured (98%), 1 improved (2%).
当CT根据该区域的颅内外血液动力学显示“筛蝶窦筛板下腔”容积减小时，“神经血管性原发性头痛”综合征也与耳鼻咽喉科相关。需要强调的是，对于耐药性头痛，只有在对某些解剖参数进行手术矫正后（P. 博纳科尔西、V.J. 诺瓦克、S. 胡佛），才能实现康复或持续的明确改善。博纳科尔西和诺瓦克独立确定了各种类型神经血管性原发性头痛的实际病理生理机制和触发区（“畸形”）。1973年至1994年间，对患有各种类型头痛（偏头痛、丛集性头痛以及所谓的特发性或原发性头痛）的446例患者进行了手术。在相应头痛侧或偶尔双侧进行鼻中隔矫正、中鼻甲和上鼻甲切除术、筛窦切除术和蝶窦切除术。大多数患者（356例，80%）术后无症状，45例（10%）偶尔有头部压迫感，但无进一步偏头痛发作，45例（10%）继续偶尔出现轻度且持续时间短的头痛。总体成功率为90%。对于20例丛集性头痛患者，我们观察到以下术后结果：19例治愈（98%），1例改善（2%）。
