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Hazewinkel MH, Knoedler L, Mathew PG, Remy K, Austen WG, Gfrerer L. Surgical Management of Headache Disorders - A Systematic Review of the Literature. Curr Neurol Neurosci Rep 2024; 24:191-202. [PMID: 38833038 DOI: 10.1007/s11910-024-01342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE OF REVIEW This review article critically evaluates the latest advances in the surgical treatment of headache disorders. RECENT FINDINGS Studies have demonstrated the effectiveness of innovative screening tools, such as doppler ultrasound, pain drawings, magnetic resonance neurography, and nerve blocks to help identify candidates for surgery. Machine learning has emerged as a powerful tool to predict surgical outcomes. In addition, advances in surgical techniques, including minimally invasive incisions, fat injections, and novel strategies to treat injured nerves (neuromas) have demonstrated promising results. Lastly, improved patient-reported outcome measures are evolving to provide a framework for comparison of conservative and invasive treatment outcomes. Despite these developments, challenges persist, particularly related to appropriate patient selection, insurance coverage, delays in diagnosis and surgical treatment, and the absence of standardized measures to assess and compare treatment impact. Collaboration between medical/procedural and surgical specialties is required to overcome these obstacles.
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Affiliation(s)
- Merel Hj Hazewinkel
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, USA
| | - Leonard Knoedler
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Paul G Mathew
- Harvard Medical School, Boston, USA
- Department of Neurology, Mass General Brigham Health, Foxborough, USA
- Department of Neurology, Atrius Health, Quincy, USA
| | - Katya Remy
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - William G Austen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Lisa Gfrerer
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, USA.
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Ormseth BH, ElHawary H, Huayllani MT, Weber KD, Blake P, Janis JE. Comparing Migraine Headache Index versus Monthly Migraine Days after Headache Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2024; 153:1201e-1211e. [PMID: 37285213 DOI: 10.1097/prs.0000000000010800] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nerve deactivation surgery for the treatment of migraine has evolved rapidly over the past 2 decades. Studies typically report changes in migraine frequency (attacks/month), attack duration, attack intensity, and their composite score-the Migraine Headache Index-as primary outcomes. However, the neurology literature predominantly reports migraine prophylaxis outcomes as change in monthly migraine days (MMD). The goal of this study was to foster common communication between plastic surgeons and neurologists by assessing the effect of nerve deactivation surgery on MMD and motivating future studies to include MMD in their reported outcomes. METHODS An updated literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Library of Medicine (PubMed), Scopus, and Embase were systematically searched for relevant articles. Data were extracted and analyzed from studies that met the inclusion criteria. RESULTS A total of 19 studies were included. There was a significant overall reduction in MMDs [mean difference (MD), 14.11; 95% CI, 10.95 to 17.27; I 2 = 92%], total migraine attacks per month (MD, 8.65; 95% CI, 7.84 to 9.46; I 2 = 90%), Migraine Headache Index (MD, 76.59; 95% CI, 60.85 to 92.32; I 2 = 98%), migraine attack intensity (MD, 3.84; 95% CI, 3.35 to 4.33; I 2 = 98%), and migraine attack duration (MD, 11.80; 95% CI, 6.44 to 17.16; I 2 = 99%) at follow-up (range, 6 to 38 months). CONCLUSION This study demonstrates the efficacy of nerve deactivation surgery on the outcomes used in both the plastic and reconstructive surgery and neurology literature.
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Affiliation(s)
| | - Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University Health Center
| | | | - Kevin D Weber
- Neurology, Ohio State University Wexner Medical Center
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Raposio G, Antonini A, Gualdi A, Raposio E. Frontal site surgery for chronic migraine therapy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023253. [PMID: 38054685 PMCID: PMC10734223 DOI: 10.23750/abm.v94i6.14777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/21/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND According to the most current theories, chronic inflammation of some cranial nerves give rise to an inflammatory chain that would result in migraines. As for frontally located attacks, the nerves involved are two (on each side): the supraorbital and the supratrochlear. Surgical treatment includes complete neurolysis of both of these nerves. METHODS In this work, we describe our experience with this type of surgery. From 2011 to 2022, we treated 98 cases suffering from chronic migraine not responsive to drugs with frontal localization. The results were evaluated through a specific questionnaire three months and one year after surgery. RESULTS After three months post-surgery, we observed a success rate (reduction of monthly attacks equivalent to or greater than 50%) in 87% of patients (32% complete recovery). These results were essentially confirmed one year after surgery. The rare complications (mainly paresthesias and dysesthesias of the frontal area) have always resolved spontaneously within a few months. CONCLUSION The surgical approach allowed to obtain good therapeutic results with a low rate of complications.
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Affiliation(s)
- Giorgio Raposio
- Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy.
| | - Andrea Antonini
- Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy.
| | | | - Edoardo Raposio
- Genova - Chirurgia Plastica Ricostruttiva ed Estetica - Terapia Cura Emicrania Cefalea..
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Raposio E, Raposio G, Duchetto DD, Tagliatti E, Cortese K. Morphologic Vascular Anomalies detected during Migraine Surgery. J Plast Reconstr Aesthet Surg 2022; 75:4069-4073. [DOI: 10.1016/j.bjps.2022.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/11/2022] [Accepted: 08/16/2022] [Indexed: 10/31/2022]
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Raposio G, Raposio E. Surgical therapy of occipital (Arnold) neuralgia: A case series. Ann Med Surg (Lond) 2022; 80:104237. [PMID: 36045775 PMCID: PMC9422306 DOI: 10.1016/j.amsu.2022.104237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objective The idea to treat occipital neuralgia patients with a surgical procedure is relatively recent. The aim of this paper was to describe the surgical techniques and our 12-year experience in this field. Materials and methods From June 2011 till February 2022 we have performed surgery over 232 patients with occipital neuralgia. Results The surgical procedure elicited a positive response in 86% of the patients. Conclusions The described techniques allowed to obtain an high rate of positive results with a minimum percentage of complications. The idea to treat occipital (Arnold) neuralgia patients with a surgical procedure is relatively recent. The aim of this paper was to describe the surgical techniques and our 12-year experience in this field. The described techniques allowed to obtain an high rate of positive results with a minimum percentage of complications.
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Affiliation(s)
- Giorgio Raposio
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy
| | - Edoardo Raposio
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy
- Plastic and Reconstructive Surgery Division, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Corresponding author. Department of Surgical Sciences and Integrated Diagnostics, University of Genova, L.go R. Benzi 10, 16132, Genova, Italy.
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Henriques S, Almeida A, Peres H, Costa-Ferreira A. Current Evidence in Migraine Surgery: A Systematic Review. Ann Plast Surg 2022; 89:113-120. [PMID: 34611094 DOI: 10.1097/sap.0000000000002989] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Migraine headache is a widespread neurovascular disorder with an enormous social and economic impact. A subgroup of patients cannot be managed with pharmacological therapy. Although surgical decompression of extracranial sensory nerves has been proposed as a valid alternative treatment option, the medical community remains reluctant to accept it. MATERIALS AND METHODS This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. An electronic search was performed in September 2020 on PubMed, ScienceDirect, CENTRAL, and Google Scholar databases for original articles reporting outcomes on migraine surgery. RESULTS The search strategy revealed a total of 922 studies, of which 52 were included in the review. Significant improvement was reported in 58.3% to 100% and complete elimination in 8.3% to 86.8% of patients across studies. No major complications were reported. DISCUSSION This systematic review demonstrates that migraine surgery is an effective and safe procedure, with a positive impact in patients' quality of life and a reduction in long-term costs. CONCLUSION There is considerable scientific evidence suggesting extracranial migraine surgery is an effective and safe procedure. This surgery should be considered in properly selected migraineurs refractory to medical treatment.
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Affiliation(s)
- Sara Henriques
- From the Department of Surgery and Physiology, Faculty of Medicine, Porto University
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Efficacy and Safety of Migraine Surgery: A Systematic Review and Meta-analysis of Outcomes and Complication Rates. Ann Surg 2022; 275:e315-e323. [PMID: 35007230 DOI: 10.1097/sla.0000000000005057] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE 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. SUMMARY BACKGROUND DATA 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. METHODS 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. RESULTS 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%). CONCLUSION 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.
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Clinical Outcome of Nerve Decompression Surgery for Migraine Improves with Nerve Wrap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3886. [PMID: 34703716 PMCID: PMC8542141 DOI: 10.1097/gox.0000000000003886] [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] [Received: 06/18/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
Background: Chronic migraine headaches affect nearly 30 million Americans every year and are responsible for roughly 1.2 million emergency department visits annually. Many of the standard therapies commonly used to treat migraines are often unsuccessful and may furthermore introduce unwanted side effects. The purpose of this study was to identify independent predictors of clinical improvement in patients undergoing surgical nerve decompression for migraine. Methods: A retrospective chart review between 2010 and 2020 was conducted. The primary endpoint was clinical improvement at 1-year follow-up, defined as an independence from prescription medications. Patients were stratified into two groups: clinical improvement and treatment failure. Backward multivariable logistic regression was used to examine the associations between migraine improvement and different patient characteristics. Results: A total of 153 patients were included. In total, 129 (84.3%) patients improved and 24 (15.7%) did not. Significant associations with clinical improvement at multivariable logistic regression were found with acellular dermal matrix nerve wrap (OR = 10.80, 95%CI: 6.18–16.27), and operation of trigger sites four (OR = 37.96, 95%CI: 2.16–73.10) and five (OR = 159, 95%CI: 10–299). Conclusion: The use of acellular dermal matrix nerve wraps in surgery was significantly associated with clinical migraine improvement, as was operation at trigger sites four and five.
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Qureshi AI, Pfeiffer K, Babar S, Huang W, Lobanova I, Ishfaq MF, French BR, Siddiq F, Gomez CR. Intra-arterial injection of lidocaine into middle meningeal artery to treat intractable headaches and severe migraine. J Neuroimaging 2021; 31:1126-1134. [PMID: 34388298 DOI: 10.1111/jon.12918] [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: 05/11/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE We report the results of intra-arterial injection of lidocaine in the middle meningeal artery in patients with intractable headache or status migrainosus. METHODS We treated four patients with intra-arterial lidocaine (2 mg/ml) in doses up to 50 mg in each middle meningeal artery via a microcatheter bilaterally (except in one patient). In two patients with intractable headache, the daily maximum intensity of headache (graded by 11-point numeric rating scale) was recorded for 7 days postprocedure. In two patients with status migrainosus, migraine-related disability 3 months prior and after treatment using MIDAS (Migraine Disability Assessment) questionnaire was recorded. RESULTS Intra-arterial lidocaine reduced the headache intensity from 8/10 and 10/10 to 0/10 in the two patients with intractable headaches for 2 days (day 0 and day 1) postprocedure. Despite recurrence of headache on day 2, the intensity was less than preprocedure intensity up to the last day recorded (by 3 and 2 points on day 7). In the two patients with status migrainosus, there was immediate reduction in headache intensity following intra-arterial lidocaine. The post treatment 3-month MIDAS score was lower in both patients compared with pretreatment 3-month score; 3 versus 30 and 55 versus 90. Severe disability preprocedure by MIDAS was reduced to little or no disability postprocedure in one patient. CONCLUSIONS Intra-arterial lidocaine resulted in amelioration of headache in patients with intractable headache and those with status migrainosus with improvement lasting longer than the short half-life of lidocaine possibly related to central desensitization.
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Affiliation(s)
- Adnan I Qureshi
- Department of Neurology, University of Missouri, Columbia, Missouri, USA.,Zeenat Qureshi Stroke Institutes
| | - Kimberley Pfeiffer
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Sehar Babar
- Department of Neurology, University of Tennessee, Memphis, Tennessee, USA
| | - Wei Huang
- Department of Neurology, University of Missouri, Columbia, Missouri, USA.,Zeenat Qureshi Stroke Institutes
| | - Iryna Lobanova
- Department of Neurology, University of Missouri, Columbia, Missouri, USA.,Zeenat Qureshi Stroke Institutes
| | - Muhammad F Ishfaq
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Brandi R French
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Farhan Siddiq
- Division of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Camilo R Gomez
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
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