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Pietramaggiori G, Bastin A, Ricci F, Bassetto F, Scherer S. Minimally invasive nerve and artery sparing surgical approach for temporal migraines. JPRAS Open 2024; 39:32-41. [PMID: 38162535 PMCID: PMC10755679 DOI: 10.1016/j.jpra.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 01/03/2024] Open
Abstract
Background Temporal migraines (TM) present with throbbing, pulsating headaches in the temporal area. Different surgical techniques ranging from resecting the auriculotemporal nerve (ATN) and or ligating the superficial temporal artery (STA) have shown similar good results to decrease TM symptoms. No conclusive data supports a specific disease of the STA in TM patients. A minimally invasive technique is proposed to preserve both vascular and nerve structures. Methods Patients with drug resistant TM were selected and treated with two techniques: nerve sparing and nerve and artery sparing. The study included 57 patients with TM, with an average age of 47.5 years. TM improvement was quantified after at least one year of follow up time. STA biopsies were sent for histological analysis. Results Forty-two patients underwent nerve-sparing decompression, with a therapeutic success rate of 78.6%, corresponding to 22.1 days with migraine per month decreasing to 6.2. Histological analysis of the STA showed varying degrees of endofibrosis in 75% of the samples. Histological results do not correlate with the intensity of symptoms before or after surgery. Fifteen patients underwent nerve and artery sparing arteriolysis, with an overall therapeutic success rate of 86.6% of which 80% had >90% improvement. The average migraine days dropped from 24 to 2.5 days per month in this group. Conclusion Minimally invasive nerve sparing approaches are an effective and safe treatment to improve drug resistant TM symptoms. Endofibrosis of the STA was present in 75% of the cases, but it was found to be unrelated to pre-operative symptoms and outcome. Results are promising, but the limited numbers of patients treated with artery and nerve sparing technique needs further investigations.
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Affiliation(s)
- Giorgio Pietramaggiori
- Global Medical Institute, Division of Aesthetic and Migraine Surgery, Avenue Jomini 8, 1004 Lausanne, Switzerland
| | - Alessandro Bastin
- University of Padua, Department of Neurosciences, Division of plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Federico Ricci
- University of Padua, Department of Neurosciences, Division of plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Franco Bassetto
- University of Padua, Department of Neurosciences, Division of plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Saja Scherer
- Global Medical Institute, Division of Aesthetic and Migraine Surgery, Avenue Jomini 8, 1004 Lausanne, Switzerland
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Gebara MA, Iwanaga J, Dumont AS, Tubbs RS. Nervous Interconnection Between the Lesser Occipital and Auriculotemporal Nerves. Cureus 2022; 14:e25643. [PMID: 35795503 PMCID: PMC9251152 DOI: 10.7759/cureus.25643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
The auriculotemporal nerve is one branch of the mandibular portion of the trigeminal nerve, which itself divides into several branches in the temporal and retromandibular regions. The lesser occipital nerve is a cutaneous branch of the cervical plexus and is sometimes implicated in cases of cervicogenic headaches, occipitoparietal headaches, and occipital neuralgia, in general. Here, we present a case of unilateral neural interconnection between the auriculotemporal and lesser occipital nerves thus illustrating the joining of the cervical plexus and trigeminal nerve. A better understanding of the aforementioned nervous anatomy may be valuable for facial reconstructive and nerve transfer procedures, as well as for a variety of other head and neck disorders, e.g., occipital neuralgia.
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Raposio G, Raposio E. Temporal surgery for chronic migraine treatment: A minimally-invasive perspective. Ann Med Surg (Lond) 2022; 76:103578. [PMID: 35495408 PMCID: PMC9052296 DOI: 10.1016/j.amsu.2022.103578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/06/2022] Open
Abstract
In this paper, we describe our mini-invasive approach for the deactivation of the auriculotemporal nerve in migraine surgery. After a mean follow-up of 21 months (range, 3–67 months), patients complaining for temporal MH had 83% positive surgical outcome (50% complete MH elimination, 33% significant improvement). Only rare minor complications are usually reported (eg, oedema, paresthesia hematoma/ecchymosis, and numbness).
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Cesarek MR, Olewnik Ł, Iwanaga J, Dumont AS, Tubbs RS. A previously unreported variant of the auriculotemporal nerve. Morphologie 2021; 106:310-313. [PMID: 34799245 DOI: 10.1016/j.morpho.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
Venous fenestrations are rare and when present often are not pierced by regional nerves. Herein, we report an unusual case of a fenestrated superficial temporal vein (STV). Anterior to the external ear, where the STV and superficial temporal artery normally travel with the auriculotemporal nerve (ATN), the nerve was found to pierce the STV. The fenestration within the STV was approximately 0.35mm in diameter, and there was no sign of compression of the ATN as it traversed this vessel. Following the site of penetration of the STV by the ATN, the nerve had a normal course into the skin and surrounding fascia. To our knowledge, this is the first report of a fenestrated STV being pierced by the ATN. Such an anatomical variation might be considered by clinicians who treat patients with pathology of this region.
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Affiliation(s)
- M R Cesarek
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Łódź, Łódź, Poland
| | - J Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - A S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - R S Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; Department of Anatomical Sciences, Saint-George's University, Saint-George's, Grenada; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Chang B, Zhu W, Zhu J, Li S. Long-term efficacy of superficial temporal artery ligation and auriculotemporal nerve transection for temporal cluster headache in adolescent. Childs Nerv Syst 2019; 35:2385-2389. [PMID: 31289856 DOI: 10.1007/s00381-019-04277-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/25/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Cluster headache is a primary headache disorder, which has affected up to 0.1% population. Superficial temporal artery ligation combined with auriculotemporal nerve transection (SLAT) is one of the surgical alternatives to treat the drug-resistant temporal cluster headache (TCH). The current work aimed to assess the effect of SLAT on TCH patients based on the very long-term clinical follow-up. METHODS The current retrospective study had enrolled 20 adolescent TCH patients undergoing SLAT between December 2016 and January 2018. The headache diaries as well as the pain severity questionnaire of the visual analog scale (VAS) had been collected to measure the pain severity before and after surgery. RESULTS The pain-free rates 3 days, as well as 1, 6, and 12 months, after SLAT surgery were 2.00%, 10.00%, 25.00%, and 70.00%, respectively. The frequency of TCH attack daily was found to be markedly reduced on the whole; besides, the pain degree was also remarkably decreased. CONCLUSIONS Results in this study indicate that the sustained headache can be relieved after SLAT in adolescent patients with intractable TCH.
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Affiliation(s)
- Bowen Chang
- Department of Neurosurgery, XinHua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Wanchun Zhu
- Department of Neurosurgery, XinHua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Jin Zhu
- Department of Neurosurgery, XinHua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Shiting Li
- Department of Neurosurgery, XinHua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
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Kikuta S, Iwanaga J, Watanabe K, Kusukawa J, Tubbs RS. Anatomical study of the supraorbital and supratrochlear nerves: A new classification and application to understanding some migraine headaches. Clin Anat 2019; 33:332-337. [DOI: 10.1002/ca.23384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Shogo Kikuta
- Seattle Science Foundation Seattle Washington
- Dental and Oral Medical CenterKurume University School of Medicine Kurume, Fukuoka Japan
| | - Joe Iwanaga
- Seattle Science Foundation Seattle Washington
- Dental and Oral Medical CenterKurume University School of Medicine Kurume, Fukuoka Japan
- Division of Gross and Clinical Anatomy, Department of AnatomyKurume University School of Medicine Kurume, Fukuoka Japan
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of AnatomyKurume University School of Medicine Kurume, Fukuoka Japan
| | - Jingo Kusukawa
- Dental and Oral Medical CenterKurume University School of Medicine Kurume, Fukuoka Japan
| | - R. Shane Tubbs
- Seattle Science Foundation Seattle Washington
- Department of Anatomical SciencesSt. George's University St. George's, Grenada West Indies
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Surgical Therapy of Temporal Triggered Migraine Headache. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1980. [PMID: 30656098 PMCID: PMC6326627 DOI: 10.1097/gox.0000000000001980] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022]
Abstract
Background The auriculotemporal and zygomaticotemporal nerves are the 2 primary trigger points in the temporal area of migraine headache. Different surgical approaches are described in literature, either open or endoscopic ones. Methods We described and delineated the currently adopted strategies to treat temporal trigger points in migraine headache. Furthermore, we reported our personal experience in the field. Results Regardless of the type of approach, outcomes observed were similar and ranged from 89% to 67% elimination / >50% reduction rates. All procedures are minimally invasive and only minor complications are reported, with an incidence ranging from 1% to 5%. Conclusions Just like upper limb compressive neuropathies, migraine headache is believed to be caused by chronic compression of peripheral nerves (ie, the terminal branches of trigeminal nerve) caused by surrounding structures (eg, muscles, vessels, and fascial bands) the removal of which eventually results in improvement or elimination of migraine attacks. Particular attention should be paid to the close nerve/artery relationship often described in anatomical studies and clinical reports.
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Yu H, Wang D, Li Q. Periotic sensory dysfunction via postauricular approach after otitis media surgery. Laryngoscope 2018; 129:454-458. [PMID: 30325498 DOI: 10.1002/lary.27318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/10/2018] [Accepted: 05/08/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Huiqian Yu
- ENT Institute and Otorhinolaryngology Department; Affiliated Eye and ENT Hospital of Fudan University and Key Laboratory of Hearing Medicine, National Health Commission of the People's Republic of China (NHCPRC); Shanghai People's Republic of China
| | - Dan Wang
- ENT Institute and Otorhinolaryngology Department; Affiliated Eye and ENT Hospital of Fudan University and Key Laboratory of Hearing Medicine, National Health Commission of the People's Republic of China (NHCPRC); Shanghai People's Republic of China
| | - Qingzhong Li
- ENT Institute and Otorhinolaryngology Department; Affiliated Eye and ENT Hospital of Fudan University and Key Laboratory of Hearing Medicine, National Health Commission of the People's Republic of China (NHCPRC); Shanghai People's Republic of China
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Ganglion Cyst of the Temporomandibular Joint Mimicking Auriculotemporal Neuralgia. J Craniofac Surg 2018; 29:e680-e682. [PMID: 30169451 DOI: 10.1097/scs.0000000000004864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Ganglion cysts within the temporomandibular joint (TMJ), although uncommon, typically present with swelling, pain, trismus, and difficulty with mastication. The authors report an unusual case of a ganglion cyst in the TMJ of a 52-year-old man who presented with chief complaints of severe headaches and dizziness that had not subsided following treatment with medication, trigger point injections, or sphenopalatine ganglion blocks. The cyst appeared as a nonenhancing, T2 hyperdensity adjacent to the left TMJ condyle on magnetic resonance imaging, supported by the presence of chronic erosion and remodeling of the anterior aspect of the left condylar head on computed tomography. The cyst was surgically removed, and the patient reported that the migraines and accompanying dizziness had ceased 6 months postoperatively. The patient's presentation and improvement following surgery suggest that the location of the cyst in the TMJ and its proximity to the course of the auriculotemporal nerve may have caused auriculotemporal neuralgia, mimicking the symptoms of migraine.
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Iwanaga J, Watanabe K, Kusukawa J, Fisahn C, Alonso F, Oskouian RJ, Tubbs RS. A novel treatment for keratitis sicca (Dry eye): Anatomical feasibility study. Clin Anat 2017. [PMID: 28631333 DOI: 10.1002/ca.22946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Chronic dry eye (keratitis sicca) is a significant problem that in certain populations can result in corneal desiccation and the potential for blindness. Therefore, novel treatments for such disorders might decrease patient morbidity. The present study aimed to investigate a potential treatment for chronic dry eye via a cadaveric feasibility study. On 10 cadaveric sides, the parotid gland branch of the auriculotemporal nerve (ATN) was identified and anastomosed to an anterior superficial temporal branch (STb) of this same nerve. The STb was then transposed anteriorly and sutured to the lacrimal gland. The parotid branch of the ATN was easily identified on all sides. The STb of the ATN was easily identified and mobilized on all sides. This latter nerve had adequate length to be moved to the ipsilateral lacrimal gland on all sides. Rerouting parotid gland secretomotor fibers to the superficial branch of the ATN and then moving this branch to the lacrimal gland is a feasible surgical maneuver based on our cadaveric study. Clinical studies are now necessary to show utility of this procedure in patients with chronic dry eye. Clin. Anat. 30:839-843, 2017. © 2017Wiley Periodicals, Inc.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Koichi Watanabe
- Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Christian Fisahn
- Seattle Science Foundation, Seattle, Washington.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Fernando Alonso
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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