Migraine surgery

Last updated

Migraine surgery is a surgical operation undertaken with the goal of reducing or preventing migraines. Migraine surgery most often refers to surgical decompression of one or several nerves in the head and neck which have been shown to trigger migraine symptoms in many migraine sufferers. [1] [2] [3] [4] Following the development of nerve decompression techniques for the relief of migraine pain in the year 2000, these procedures have been extensively studied and shown to be effective in appropriate candidates. [5] [6] [7] The nerves that are most often addressed in migraine surgery are found outside of the skull, in the face and neck, and include the supra-orbital and supra-trochlear nerves in the forehead, the zygomaticotemporal nerve and auriculotemporal nerves in the temple region, and the greater occipital, lesser occipital, and third occipital nerves in the back of the neck. [8] [1] [9] [3] [2] [4] [10] [11] [12] Nerve impingement in the nasal cavity has additionally been shown to be a trigger of migraine symptoms.

Contents

Indications and patient selection

Migraine surgery is usually reserved for migraine patients who fail more conservative therapy or who cannot tolerate the side effects of drugs used to treat their migraines. Appropriate patients are screened using injections of local anesthesia to provide a temporary nerve block. In some cases, Botox may be used to provide temporary decompression of the nerve. Patients who respond to nerve blocks often see an immediate though temporary reduction in their pain by "shutting off" the nerve that is triggering the migraine, while pain relief following Botox injections is provided by relaxation of nearby muscle tissue that may be compressing the nerve. Patients who respond well to these screening procedures are felt to be excellent candidates for migraine surgery. [13] [6] [14] [15]

Surgical procedures

Migraine surgery is an outpatient procedure which addresses peripheral nerves through limited incisions. Depending on the symptoms of the patient and the screening results following nerve blocks or Botox, different areas of the head and neck may be addressed to treat the nerves found to be the migraine trigger in a given patient. Migraine surgery is always individualized to each patient's symptoms and anatomy.

Anterior nerves

Nerves found in the forehead (supra-orbital and supra-trochlear nerves) are either addressed using endoscopic surgery or by using an incision in the crease of the upper eyelid. [16] [17] Structures that are found pressing on the nerves here are released and may include bone at the upper orbit, fascia, blood vessels, or muscle tissue. The supra-orbital and supra-trochlear nerves travel through the corrugator supercilii muscle which enables frowning of the brow. These nerves are released from these muscles so they may lie free of pressure from these muscle structures. Small blood vessels which travel with these nerves may be divided to prevent pressure as well. In the bony notch where these nerves exit the eye socket, small pieces of bone or connective tissue may be removed so undue pressure is not placed on the nerves in this region. [18] [19] [20]

Nerves of the temple region

The zygomaticotemporal nerve and auriculotemporal nerves are found in areas between the top of the ear and the lateral portion of the eye, in different areas of the temple. These nerves can also be addressed by endoscopic techniques, or well hidden small incisions. Blood vessels next to or crossing these nerves are often found to be the source of compression, and these blood vessels may be divided to prevent irritation of these nerves. Associated temporal muscle release in the region of these nerves may also be indicated. [21] Because these nerves are very small and provide feeling to small regions of the scalp, they are often cut or avulsed, allowing the ends to retract into muscle tissue to prevent neuroma formation. [22]

Posterior nerves

Chronic irritation of the occipital nerves is called occipital neuralgia and is frequently the cause of migraine symptoms. The greater occipital and third occipital nerves are addressed through an incision at the base of the scalp in the upper neck by either a vertical or transverse incision. Incisions are usually placed within the hairline. The greater occipital nerve travels through several muscle layers (including the trapezius muscle and splenius capitis muscle) where it is often compressed, and therefore surgery for this nerve involves releasing it from tight muscle and fascia in the upper neck. Blood vessels found crossing the nerve such as the occipital artery may be divided in order to avoid chronic pressure and irritation of the greater occipital nerve. [2] [23] The third occipital nerve is a small nerve that travels near the greater occipital nerve and may treated similarly in order to alleviate chronic irritation. [11]

The lesser occipital nerve is a small nerve that has additionally been found to be associated with migraine pain. This nerve is found near the sternocleidomastoid muscle and may be decompressed or divided here through a small incision. As this small nerve provides feeling for a small region of the scalp, the minimal numbness resulting from the division of this nerve often goes un-noticed. [8] [11]

Nerves of the nose

The nerves of the nasal lining may be impinged by structures in the nose such as the nasal septum and turbinates. Nasal surgery to decompress these regions may include septoplasty, turbinectomy, or other rhinoplasty procedures. [24]

Surgical outcomes

Though initially thought to be experimental surgery, the benefits of migraine surgery have now been well documented. Followup data has shown that 88% of migraine surgery patients experienced a positive response to the procedure after 5 years. 29% of patients have been shown to achieve complete elimination of their migraine disease, while an additional 59% of patients reported a significant decrease in their pain and symptoms 5 years following their migraine surgery. 12% of patients undergoing migraine surgery reported no change in their symptoms after 5 years. [5] [6] [7] [25]

Migraine surgery has additionally been studied in a socioeconomic context and has been shown to reduce both direct and indirect costs associated with migraine disease. Such costs after migraine surgery have been shown to be reduced by a median of $3,949 per patient per year. [26]

Related Research Articles

Botulinum toxin Neurotoxic protein produced by Clostridium botulinum

Botulinum toxin (BoNT) is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction, thus causing flaccid paralysis. The toxin causes the disease botulism. The toxin is also used commercially for medical and cosmetic purposes.

Bells palsy Facial paralysis resulting from dysfunction in the cranial nerve VII (facial nerve)

Bell's palsy is a type of facial paralysis that results in a temporary inability to control the facial muscles on the affected side of the face. Symptoms can vary from mild to severe. They may include muscle twitching, weakness, or total loss of the ability to move one or, in rare cases, both sides of the face. Other symptoms include drooping of the eyelid, a change in taste, and pain around the ear. Typically symptoms come on over 48 hours. Bell's palsy can trigger an increased sensitivity to sound known as hyperacusis.

Rhinoplasty

Rhinoplasty, commonly called nose job, medically called nasal reconstruction is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery can also treat birth defects, breathing problems, and failed primary rhinoplasties. Rhinoplasty may remove a bump, narrow nostril width, change the angle between the nose and the mouth, or address injuries, birth defects, or other problems that affect breathing, such as a deviated nasal septum or a sinus condition.

Trigeminal neuralgia Neurological pain disorder

Trigeminal neuralgia is a long-term pain disorder that affects the trigeminal nerve, the nerve responsible for sensation in the face and motor functions such as biting and chewing. It is a form of neuropathic pain. There are two main types: typical and atypical trigeminal neuralgia. The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes. Groups of these episodes can occur over a few hours. The atypical form results in a constant burning pain that is less severe. Episodes may be triggered by any touch to the face. Both forms may occur in the same person. It is regarded to be one of the most painful disorders known to medicine, and often results in depression.

Breast augmentation Surgical procedure

Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts of a woman. Augmentation mammoplasty is applied to correct congenital defects of the breasts and the chest wall. As an elective cosmetic surgery, primary augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.

Breast reduction Plastic surgery procedure

Reduction mammoplasty is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the woman's body, the critical corrective consideration is the tissue viability of the nipple–areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts. The indications for breast reduction surgery are three-fold – physical, aesthetic, and psychological – the restoration of the bust, of the woman's self-image, and of her mental health.

Rhytidectomy

A facelift, technically known as a rhytidectomy, is a type of cosmetic surgery procedure used to give a more youthful facial appearance. There are multiple surgical techniques and exercise routines. Surgery usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. Exercise routines tone underlying facial muscles without surgery. Surgical facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep.

Occipital neuralgia (ON) is a painful condition affecting the posterior head in the distributions of the greater occipital nerve (GON), lesser occipital nerve (LON), third occipital nerve (TON), or a combination of the three. It is paroxysmal, lasting from seconds to minutes, and often consists of lancinating pain that directly results from the pathology of one of these nerves. It is paramount that physicians understand the differential diagnosis for this condition and specific diagnostic criteria. There are multiple treatment modalities, several of which have well-established efficacy in treating this condition.

Buttock augmentation Cosmetic and corrective surgery

Gluteoplasty denotes the plastic surgery and the liposuction procedures for the correction of the congenital, traumatic, and acquired defects and deformities of the buttocks and the anatomy of the gluteal region; and for the aesthetic enhancement of the contour of the buttocks.

Breast implant Prosthesis used to change the size, shape, and contour of a persons breast

A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast following a mastectomy, to correct congenital defects and deformities of the chest wall or, cosmetically, to enlarge the appearance of the breast through breast augmentation surgery.

Superior cluneal nerves

The superior cluneal nerves are pure sensory nerves that innervate the skin of the upper part of the buttocks. They are the terminal ends of the L1-L3 spinal nerve dorsal rami lateral branches. They are one of three different types of cluneal nerves. Dysfunction of the superior cluneal nerves is often due to entrapment as the nerves cross the iliac crest – this can result in numbness, tingling or pain in the low back and upper buttocks region. Superior cluneal nerve dysfunction is a clinical diagnosis that can be supported by diagnostic nerve blocks.

Buccal fat pad

The buccal fat pad, is one of several encapsulated fat masses in the cheek. It is a deep fat pad located on either side of the face between the buccinator muscle and several more superficial muscles. The inferior portion of the buccal fat pad is contained within the buccal space. It should not be confused with the malar fat pad, which is directly below the skin of the cheek. It should also not be confused with jowl fat pads. It is implicated in the formation of hollow cheeks and the nasolabial fold, but not in the formation of jowls.

Liposuction Procedure used in plastic surgery to remove unwanted fat

Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. In the United States, liposuction is the most common cosmetic surgery.

Preventive treatment of migraines can be an important component of migraine management. Such treatments can take many forms, including everything from surgery, taking certain drugs or nutritional supplements, to lifestyle alterations such as increased exercise and avoidance of migraine triggers.

Scalp reconstruction is a surgical procedure for people with scalp defects. Scalp defects may be partial or full thickness and can be congenital or acquired. Because not all layers of the scalp are elastic and the scalp has a convex shape, the use of primary closure is limited. Sometimes the easiest way of closing the wound may not be the ideal or best way. The choice for a reconstruction depends on multiple factors, such as the defect itself, the patient characteristics and surgeon preference.

Babak Azizzadeh American facial plastic and reconstructive surgeon

Babak Azizzadeh, MD, FACS is the founder and president of the FPBPF, a non-profit organization committed to the treatment of individuals with facial nerve paralysis and Bell's palsy.

Occipital nerve stimulation (ONS), also called peripheral nerve stimulation (PNS) of the occipital nerves, is used to treat chronic migraine patients who have failed to respond to pharmaceutical treatments.

Migraine treatment may be either prophylactic (preventive) or abortive (rescue). Prevention is better than cure, so the ideal treatment goal is to prevent migraine attacks. Because migraine is an exceedingly complex condition, there are various preventive treatments which have their effect by disrupting different links in the chain of events that occur during a migraine attack. As rescue treatments also target and disrupt different processes occurring during migraine, these are summarized, with their relative merits and demerits.

Perforator flap surgery is a technique used in reconstructive surgery where skin and/or subcutaneous fat are removed from a distant or adjacent part of the body to reconstruct the excised part. The vessels that supply blood to the flap are isolated perforator(s) derived from a deep vascular system through the underlying muscle or intermuscular septa. Some perforators can have a mixed septal and intramuscular course before reaching the skin. The name of the particular flap is retrieved from its perforator and not from the underlying muscle. If there is a potential to harvest multiple perforator flaps from one vessel, the name of each flap is based on its anatomical region or muscle. For example, a perforator that only traverses through the septum to supply the underlying skin is called a septal perforator. Whereas a flap that is vascularised by a perforator traversing only through muscle to supply the underlying skin is called a muscle perforator. According to the distinct origin of their vascular supply, perforators can be classified into direct and indirect perforators. Direct perforators only pierce the deep fascia, they don't traverse any other structural tissue. Indirect perforators first run through other structures before piercing the deep fascia.

Carpal tunnel surgery

Carpal tunnel surgery, also called carpal tunnel release (CTR) and carpal tunnel decompression surgery, is a surgery in which the transverse carpal ligament is divided. It is a surgical treatment for carpal tunnel syndrome (CTS) and recommended when there is constant numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms of pain in the carpal tunnel. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment.Long-term outcomes of carpal tunnel release: a critical review of the literature Approximately 500,000 surgical procedures are performed each year, and the economic impact of this condition is estimated to exceed $2 billion annually.

References

  1. 1 2 Ducic I, Moriarty M, Al-Attar A (March 2009). "Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches". Plastic and Reconstructive Surgery. 123 (3): 859–63, discussion 864. doi:10.1097/prs.0b013e318199f080. PMID   19319048.
  2. 1 2 3 Janis JE, Hatef DA, Reece EM, McCluskey PD, Schaub TA, Guyuron B (December 2010). "Neurovascular compression of the greater occipital nerve: implications for migraine headaches". Plastic and Reconstructive Surgery. 126 (6): 1996–2001. doi:10.1097/prs.0b013e3181ef8c6b. PMID   21124138.
  3. 1 2 Ascha M, Kurlander DE, Sattar A, Gatherwright J, Guyuron B (June 2017). "In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV)". Plastic and Reconstructive Surgery. 139 (6): 1333e–1342e. doi:10.1097/prs.0000000000003395. PMID   28538577.
  4. 1 2 Mosser SW, Guyuron B, Janis JE, Rohrich RJ (February 2004). "The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches". Plastic and Reconstructive Surgery. 113 (2): 693–7, discussion 698–700. doi:10.1097/01.prs.0000101502.22727.5d. PMID   14758238.
  5. 1 2 Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S (August 2009). "A placebo-controlled surgical trial of the treatment of migraine headaches". Plastic and Reconstructive Surgery. 124 (2): 461–8. doi:10.1097/prs.0b013e3181adcf6a. PMID   19644260.
  6. 1 2 3 Janis JE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B (October 2014). "A review of current evidence in the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 134 (4 Suppl 2): 131S–41S. doi:10.1097/prs.0000000000000661. PMID   25254996.
  7. 1 2 Guyuron B, Kriegler JS, Davis J, Amini SB (February 2011). "Five-year outcome of surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 127 (2): 603–8. doi:10.1097/prs.0b013e3181fed456. PMID   20966820.
  8. 1 2 Lee M, Brown M, Chepla K, Okada H, Gatherwright J, Totonchi A, Alleyne B, Zwiebel S, Kurlander D, Guyuron B (December 2013). "An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 132 (6): 1551–6. doi:10.1097/prs.0b013e3182a80721. PMID   24005368.
  9. ↑ Janis JE, Hatef DA, Hagan R, Schaub T, Liu JH, Thakar H, Bolden KM, Heller JB, Kurkjian TJ (April 2013). "Anatomy of the supratrochlear nerve: implications for the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 131 (4): 743–50. doi:10.1097/prs.0b013e3182818b0c. PMID   23249981.
  10. ↑ Chim H, Okada HC, Brown MS, Alleyne B, Liu MT, Zwiebel S, Guyuron B (August 2012). "The auriculotemporal nerve in etiology of migraine headaches: compression points and anatomical variations". Plastic and Reconstructive Surgery. 130 (2): 336–41. doi:10.1097/prs.0b013e3182589dd5. PMID   22842409.
  11. 1 2 3 Dash KS, Janis JE, Guyuron B (May 2005). "The lesser and third occipital nerves and migraine headaches". Plastic and Reconstructive Surgery. 115 (6): 1752–8, discussion 1759–60. doi:10.1097/01.prs.0000161679.26890.ee. PMID   15861086.
  12. ↑ Janis JE, Hatef DA, Thakar H, Reece EM, McCluskey PD, Schaub TA, Theivagt C, Guyuron B (August 2010). "The zygomaticotemporal branch of the trigeminal nerve: Part II. Anatomical variations". Plastic and Reconstructive Surgery. 126 (2): 435–42. doi:10.1097/prs.0b013e3181e094d7. PMID   20375758.
  13. ↑ Lee M, Monson MA, Liu MT, Reed D, Guyuron B (April 2013). "Positive botulinum toxin type a response is a prognosticator for migraine surgery success". Plastic and Reconstructive Surgery. 131 (4): 751–7. doi:10.1097/prs.0b013e3182818b7f. PMID   23542247.
  14. ↑ Guyuron B, Nahabet E, Khansa I, Reed D, Janis JE (October 2015). "The Current Means for Detection of Migraine Headache Trigger Sites". Plastic and Reconstructive Surgery. 136 (4): 860–7. doi:10.1097/prs.0000000000001572. PMID   26397259.
  15. ↑ Janis JE, Dhanik A, Howard JH (July 2011). "Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression". Plastic and Reconstructive Surgery. 128 (1): 123–31. doi:10.1097/prs.0b013e3182173d64. PMID   21701329.
  16. ↑ Gfrerer L, Maman DY, Tessler O, Austen WG (October 2014). "Nonendoscopic deactivation of nerve triggers in migraine headache patients: surgical technique and outcomes". Plastic and Reconstructive Surgery. 134 (4): 771–8. doi:10.1097/prs.0000000000000507. PMID   24945947.
  17. ↑ Liu MT, Chim H, Guyuron B (May 2012). "Outcome comparison of endoscopic and transpalpebral decompression for treatment of frontal migraine headaches". Plastic and Reconstructive Surgery. 129 (5): 1113–9. doi:10.1097/prs.0b013e31824a2c31. PMID   22544095.
  18. ↑ Chepla KJ, Oh E, Guyuron B (April 2012). "Clinical outcomes following supraorbital foraminotomy for treatment of frontal migraine headache". Plastic and Reconstructive Surgery. 129 (4): 656e–62e. doi:10.1097/prs.0b013e3182450b64. PMC   3315686 . PMID   22456379.
  19. ↑ Hagan RR, Fallucco MA, Janis JE (July 2016). "Supraorbital Rim Syndrome: Definition, Surgical Treatment, and Outcomes for Frontal Headache". Plastic and Reconstructive Surgery Global Open. 4 (7): e795. doi:10.1097/gox.0000000000000802. PMC   4977123 . PMID   27536474.
  20. ↑ Fallucco M, Janis JE, Hagan RR (December 2012). "The anatomical morphology of the supraorbital notch: clinical relevance to the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 130 (6): 1227–33. doi:10.1097/prs.0b013e31826d9c8d. PMID   23190806.
  21. ↑ Kurlander DE, Punjabi A, Liu MT, Sattar A, Guyuron B (April 2014). "In-depth review of symptoms, triggers, and treatment of temporal migraine headaches (Site II)". Plastic and Reconstructive Surgery. 133 (4): 897–903. doi:10.1097/prs.0000000000000045. PMID   24675192.
  22. ↑ Guyuron B, Harvey D, Reed D (July 2015). "A Prospective Randomized Outcomes Comparison of Two Temple Migraine Trigger Site Deactivation Techniques". Plastic and Reconstructive Surgery. 136 (1): 159–65. doi:10.1097/prs.0000000000001322. PMID   25829156.
  23. ↑ Chmielewski L, Liu MT, Guyuron B (March 2013). "The role of occipital artery resection in the surgical treatment of occipital migraine headaches". Plastic and Reconstructive Surgery. 131 (3): 351e–6e. doi:10.1097/prs.0b013e31827c6f71. PMID   23446584.
  24. ↑ Behin F, Behin B, Bigal ME, Lipton RB (June 2005). "Surgical treatment of patients with refractory migraine headaches and intranasal contact points". Cephalalgia. 25 (6): 439–43. doi:10.1111/j.1468-2982.2004.00877.x. PMID   15910568.
  25. ↑ Guyuron B, Lineberry K, Nahabet EH (June 2015). "A retrospective review of the outcomes of migraine surgery in the adolescent population". Plastic and Reconstructive Surgery. 135 (6): 1700–5. doi:10.1097/prs.0000000000001270. PMID   26017602.
  26. ↑ Faber C, Garcia RM, Davis J, Guyuron B (April 2012). "A socioeconomic analysis of surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 129 (4): 871–7. doi:10.1097/prs.0b013e318244217a. PMID   22183497.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.