Minimally invasive nerve and artery sparing surgical approach for temporal migraines
Summary: 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 s...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | JPRAS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352587823000839 |
| _version_ | 1797291785359196160 |
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| author | Giorgio Pietramaggiori Alessandro Bastin Federico Ricci Franco Bassetto Saja Scherer |
| author_facet | Giorgio Pietramaggiori Alessandro Bastin Federico Ricci Franco Bassetto Saja Scherer |
| author_sort | Giorgio Pietramaggiori |
| collection | DOAJ |
| description | Summary: 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. |
| first_indexed | 2024-03-07T19:41:48Z |
| format | Article |
| id | doaj.art-a6dea38441ad4e6f8e91922268348333 |
| institution | Directory Open Access Journal |
| issn | 2352-5878 |
| language | English |
| last_indexed | 2024-03-07T19:41:48Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JPRAS Open |
| spelling | doaj.art-a6dea38441ad4e6f8e919222683483332024-02-29T05:19:30ZengElsevierJPRAS Open2352-58782024-03-01393241Minimally invasive nerve and artery sparing surgical approach for temporal migrainesGiorgio Pietramaggiori0Alessandro Bastin1Federico Ricci2Franco Bassetto3Saja Scherer4Global Medical Institute, Division of Aesthetic and Migraine Surgery, Avenue Jomini 8, 1004 Lausanne, Switzerland; Corresponding author.University of Padua, Department of Neurosciences, Division of plastic Surgery, Via Giustiniani 2, 35128 Padova, ItalyUniversity of Padua, Department of Neurosciences, Division of plastic Surgery, Via Giustiniani 2, 35128 Padova, ItalyUniversity of Padua, Department of Neurosciences, Division of plastic Surgery, Via Giustiniani 2, 35128 Padova, ItalyGlobal Medical Institute, Division of Aesthetic and Migraine Surgery, Avenue Jomini 8, 1004 Lausanne, SwitzerlandSummary: 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.http://www.sciencedirect.com/science/article/pii/S2352587823000839Temporal migrainesSuperficial temporal artery (STA)Auriculotemporal nerve (ATN)Minimally invasive surgeryMigraine surgery |
| spellingShingle | Giorgio Pietramaggiori Alessandro Bastin Federico Ricci Franco Bassetto Saja Scherer Minimally invasive nerve and artery sparing surgical approach for temporal migraines JPRAS Open Temporal migraines Superficial temporal artery (STA) Auriculotemporal nerve (ATN) Minimally invasive surgery Migraine surgery |
| title | Minimally invasive nerve and artery sparing surgical approach for temporal migraines |
| title_full | Minimally invasive nerve and artery sparing surgical approach for temporal migraines |
| title_fullStr | Minimally invasive nerve and artery sparing surgical approach for temporal migraines |
| title_full_unstemmed | Minimally invasive nerve and artery sparing surgical approach for temporal migraines |
| title_short | Minimally invasive nerve and artery sparing surgical approach for temporal migraines |
| title_sort | minimally invasive nerve and artery sparing surgical approach for temporal migraines |
| topic | Temporal migraines Superficial temporal artery (STA) Auriculotemporal nerve (ATN) Minimally invasive surgery Migraine surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2352587823000839 |
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