Selective denervation of the corrugator supercilii muscle for the treatment of idiopatic trigeminal neuralgia purely paroxysmal distributed in the supraorbital and suprathrochlear dermatomes

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Abstract

Introduction

Idiopatic trigeminal neuralgia purely paroxysmal (ITNp) distributed in the supraorbital and suprathrochlear dermatomes (SSd), refractory to conventional treatments have been linked to the hyperactivity of the corrugator supercilii muscle (CSM). In these patients, the inactivation of the CSM via botulinum toxin type A (BTA) injections has been proven to be safe and effective in reducing migraine burden. The main limitation of BTA is the need of repetitive injections and relative high costs. Based on the study of the motor innervation of the CSM, we describe here an alternative approach to improve these type of migraines, based on a minimally invasive denervation of the CSM.

Materials and methods

Motor innervation and feasibility of selective CSM denervation was first studied on fresh frozen cadavers. Once the technique was safely established, 15 patients were enrolled. To be considered eligible, patients had to meet the following criteria: positive response to BTA treatment, migraine disability assessment score > 24, > 15 migraine days/month, no occipital/temporal trigger points and plausible reasons to discontinue BTA treatment. Pre- and post- operative migraine headache index (MHI) were compared, and complications were classified following the Clavien-Dindo classification (CDC).

Results

Fifteen patients (9 females and 6 males) underwent the described surgical procedure. The mean age was 41 ± 10 years. Migraine headache episodes decreased from 24 ± 4 day/month to 2 ± 2 ( p < 0.001) The MHI decreased from 208 ± 35 to 10 ± 11 ( p < 0.001). One patient (7%) had a grade I complication according to the CDC. No patient needed a second operative procedure.

Conclusions

Our findings suggest that the selective CSM denervation represents a safe and minimally invasive approach to improve ITNp distributed in the SSd associated with CSM hyperactivation.

Trial registration

The data collection was conducted as a retrospective quality assessment study and all procedures were performed in accordance with the ethical standards of the national research committee and the 1964 Helsinki Declaration and its later amendments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-021-01218-6.

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Most cited references 32

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Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.

Daniel Dindo, Nicolas Demartines, Pierre-Alain Clavien (2004)

Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers and therapies and over time. A classification of complications published by one of the authors in 1992 was critically re-evaluated and modified to increase its accuracy and its acceptability in the surgical community. Modifications mainly focused on the manner of reporting life-threatening and permanently disabling complications. The new grading system still mostly relies on the therapy used to treat the complication. The classification was tested in a cohort of 6336 patients who underwent elective general surgery at our institution. The reproducibility and personal judgment of the classification were evaluated through an international survey with 2 questionnaires sent to 10 surgical centers worldwide. The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons. The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world.

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Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention.

Richard Lipton, Stephen D. Silberstein (2015)

Migraine is a common disabling primary headache disorder that affects an estimated 36 million Americans. Migraine headaches often occur over many years or over an individual's lifetime. By definition, episodic migraine is characterized by headaches that occur on fewer than 15 days per month. According to the recent International Classification of Headache Disorders (third revision) beta diagnostic criteria, chronic migraine is defined as "headaches on at least 15 days per month for at least 3 months, with the features of migraine on at least 8 days per month." However, diagnostic criteria distinguishing episodic from chronic migraine continue to evolve. Persons with episodic migraine can remit, not change, or progress to high-frequency episodic or chronic migraine over time. Chronic migraine is associated with a substantially greater personal and societal burden, more frequent comorbidities, and possibly with persistent and progressive brain abnormalities. Many patients are poorly responsive to, or noncompliant with, conventional preventive therapies. The primary goals of migraine treatment include relieving pain, restoring function, and reducing headache frequency; an additional goal may be preventing progression to chronic migraine. Although all migraineurs require abortive treatment, and all patients with chronic migraine require preventive treatment, there are no definitive guidelines delineating which persons with episodic migraine would benefit from preventive therapy. Five US Food and Drug Association strategies are approved for preventing episodic migraine, but only injections with onabotulinumtoxinA are approved for preventing chronic migraine. Identifying persons who require migraine prophylaxis and selecting and initiating the most appropriate treatment strategy may prevent progression from episodic to chronic migraine and alleviate the pain and suffering associated with frequent migraine. © 2015 American Headache Society.

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Usefulness of the SF-8 Health Survey for comparing the impact of migraine and other conditions.

Diane Turner-Bowker, Martha Bayliss, John E Ware … (2003)

Migraine headaches have been shown to have substantial personal and societal implications. Health-related quality of life (HRQOL) assessments of migraineurs have been used to monitor and evaluate patient- and population-based outcomes, and to evaluate effectiveness and responsiveness to treatment. In this paper, we test a new, even shorter generic health survey, the SF-8 Health Survey (SF-8), an alternate form that uses one question to measure each of the eight SF-36 Health Survey (SF-36) domains, in a sub-sample of migraine sufferers. Data from 7557 participants surveyed via the Internet and mail were used to document the burden of migraine on HRQOL and to compare the relative burden of migraine with other chronic conditions using the SF-8. Migraineurs' HRQOL is similar to those with congestive heart failure, hypertension and diabetes, and is better than those with depression. Migraine sufferers experience better physical health and worse mental health (MH) than those with osteoarthritis. Results support prior research indicating that the burden of migraine on functional health and well-being is considerable and comparable to other chronic conditions known to have substantial impact on HRQOL. The SF-8 may provide a more practical and efficient method to describe the burden of migraine in population studies.

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Author and article information

Contributors

Giorgio Pietramaggiori: dr.pietramaggiori@global.surgery

Journal

Journal ID (nlm-ta): J Headache Pain

Journal ID (iso-abbrev): J Headache Pain

Title: The Journal of Headache and Pain

Publisher: Springer Milan (Milan )

ISSN (Print): 1129-2369

ISSN (Electronic): 1129-2377

Publication date (Electronic): 4 March 2021

Publication date PMC-release: 4 March 2021

Publication date Collection: 2021

Volume: 22

Issue: 1

Electronic Location Identifier: 9

Affiliations

[1 ]GRID grid.15496.3f, University Vita-Salute San Raffaele, ; Milan, Italy

[2 ]Surgical Medical Group, Milan, Italy

[3 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, , Medical University of Graz, ; Graz, Austria

[4 ]Peled Plastic Surgery, San Francisco, California USA

[5 ]Neuropax Clinic, St. Louis, MO USA

[6 ]GRID grid.5611.3, ISNI 0000 0004 1763 1124, Maxillo Facial, Plastic Surgery Unit, Department of Surgery, Policlinico G.B. Rossi, , University of Verona, ; Verona, Italy

[7 ]GRID grid.4464.2, ISNI 0000 0001 2161 2573, Clinical Professor, Centre for Integrated Medical and Translational Research, , University of London, ; London, UK

[8 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Research Unit Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, , Medical University of Graz, ; Graz, Austria

[9 ]Global Medical Institute and Swiss Nerve Center, Lausanne, Switzerland

[10 ]GRID grid.5608.b, ISNI 0000 0004 1757 3470, Plastic and Reconstructive Surgery, Department of Neurosciences, , University of Padua, ; Padua, Italy

Article

Publisher ID: 1218

DOI: 10.1186/s10194-021-01218-6

PMC ID: 7931360

SO-VID: bfaa4f3a-fb00-4d09-bcdb-834c025a4f49

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 5 January 2021

Date accepted : 15 February 2021

Custom metadata

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: migraine disorders,headache disorders,quality of life,neuralgia,botulinum toxin type a

Data availability:

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: migraine disorders, headache disorders, quality of life, neuralgia, botulinum toxin type a

Selective denervation of the corrugator supercilii muscle for the treatment of idiopatic trigeminal neuralgia purely paroxysmal distributed in the supraorbital and suprathrochlear dermatomes

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Abstract

Introduction

Materials and methods

Results

Conclusions

Trial registration

Supplementary Information

Related collections

Asian Journal of Quality of Life (AjQoL)

Most cited references 32

Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.

Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention.

Usefulness of the SF-8 Health Survey for comparing the impact of migraine and other conditions.

Author and article information

Contributors

Journal

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Article

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