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Over the last 10 years, the LF-medical group adapted a new, safe and minimally invasive surgical treatment for most debilitating forms of headache. The technique was investigated and published in peer reviewed journals. The procedure is based on the decompression of nerve trigger points and therefore tentatively called nerve decompression headache surgery, by others tagged with the more popularized phrase “migraine surgery”.
Nerve decompression surgery to treat headache involves decompression of peripheral sensory nerve branches in 3 different head and neck areas (frontal, temporal and occipital), which are believed to be migraine trigger points.
Migraines have long been associated with the compression and irritation of key sensory nerves of the face and head by their surrounding muscle, fascia and periosteum. In case of severe headache these nerves are of course also genetically susceptible to such compression.
Surgically relieving the pressure on compressed nerves may reduce the frequency, severity and duration of headaches, or even eliminate the headache completely. In our recently published study with a 10 years follow up we could show that for the proper indications surgery is the most effective treatment when compared to different medication therapy or botulin toxin injections, with almost no side effects.
- Safe and minimally invasive procedure
- In around 90% of patients one can expect at least more than 50% reduction of frequency, severity and duration of headaches. However, frequently also complete elimination of the headache attacks
- Able to go home in only one day with recovery time of less than 7 days
- No visible scars
- Sensory nerves are only decompressed, and completely preserved
- Lowest possible adverse effect
- Chronic type of headache, migraine, tension type headache, chronic daily headache
- Candidates that passed the LF-medical group screening protocol
Not good candidates:
- Candidates that did not pass the LF-medical group screening protocol
WHAT RESULTS TO EXPECT?
Evidence about the efficacy of migraine surgery is accumulating rapidly as different surgical groups around the world are continuously reporting and publishing their results. In most cases the surgery has a long-lasting effect. In these studies, outcome was measured by the percentage of patients who experienced postoperative reduction of headache symptoms of 50% or more. Under these terms surgical success rates of latest published studies have improved to almost 95%.
We also recently published a study with a long follow up (10 years) in which we showed that migraine surgery is an extremely effective and safe treatment for headache in a carefully selected group of patients.
In the headache center of the LF -Medical group we developed a multidisciplinary screening protocol involving both a surgeon and a neurologist to identify those headache patients which have the highest chance for a successful surgical treatment outcome.
During your consultation our neurologist will take your patient history, perform a physical examination, and help you to finish some questionnaires to categorize your headache symptoms and characteristics.
CT scan of the head and neck is routinely performed in previously selected patients to exclude secondary pathology (frontal sinusitis, concha bullosa, nasal points of mucosa impact, etc.) that can also cause pain sensation in specific areas. This is important because some patients with frontal headache should be treated with sinus surgery or septal surgery.
The screening protocol includes in most cases a nerve block and a botuline toxin injection trial as additional diagnostic tools. A nerve block is simply an injection of local anesthetic directly into the trigger area. If the anesthetic block immediately decreases the pain for a short period of time (hours) this is considered a good indication for surgery. The same holds true for injections with botuline toxin around the nerve, which usually has a little longer effect (weeks to months).
With all diagnostic information gathered by our multidisciplinary team we will make an individualized treatment plan. Sometimes this involves medication trials, sometimes injections with botulin toxin, sometimes surgery and sometimes a combination of treatments.
HOW TO PREPARE FOR TREATMENT?
Nerve decompression or migraine surgery is performed under general
anesthesia for which we will execute some preoperative
- Laboratory testing – blood work, EKG, etc.
- Medical evaluation by the anesthesiologist in our OR center
- Certain medication or adjust current medication
Your surgeon will ask you about your past medical history, medications, allergies, previous surgery and more. You are to avoid taking aspirin, anti-inflammatory drugs, warfarin sodium and other supplements as they can increase bleeding and bruising. It's important to understand all aspects of your surgery. It's natural to be nervous about it so don't be shy to discuss your concerns with your surgeon.
Know more about
Migraine surgery is performed in 3 different head and neck areas depending on the location of the headache.
1) Frontal area – decompression of supraorbital and supratrochlear nerves
The most common headache area that we see in our practice is the frontal area for which we use and endoscopic approach with a camera trough one small skin incision placed in the hairline to make the scar more or less invisible.
Under direct control of the endoscope a special instrument is used to elevate the skin–muscle–periosteum flap in a subperiosteal plane. Dissection is carried caudally until the supraorbital rims are visualized at which level the periosteum is incised and separated until both supraorbital and supratrochlear nerves and accompanying vessels are well visualized. This procedure is safe and in our hands proved to be extremely efficient to achieve the necessary level of muscle and periosteum de-entrapment of the nerves finally resulting in an satisfactory postoperative frontal pain relief.
2) Temporal area – decompression of the zygomaticotemporal nerve
Trigger areas on the temples can be treated surgically by the same principle. Pressure is relieved on the zygomaticotemporal nerve through keyhole surgery, with the surgeon accessing the nerve via a section of the temple that is covered by hair.
3) Occipital area – decompression of the occipital nerve
The third possibility is to relieve pressure on a nerve located in the posterior neck. The greater occipital nerve provides sensation for most of the back and top of the head (and can cause pain as far forward as the eyes). Tight neck muscles and their covering tissue layer also known as fascia are usually the cause of nerve entrapment and therefore the common site for migraine triggering. Through a single incision in the back of the neck we are able to remove enough of tissue surrounding this large nerve to decompress it to help it function normally again. The whole procedure takes around 2-3 h with preparation. Shortly after the treatment you are able to go to your home to recover. We will provide each patient with simple post-surgical instructions. It is recommended that patients arrange to have a ride home following the procedure.
Time to heal
During the following day, you will come to our clinic for a checkup, where we will check if everything is looking perfect and healing properly. Pain medication may be prescribed if needed. Recovery following migraine surgery involves little to no downtime. Some patients may experience minor swelling and bruising which will subside by itself over the first few days of recovery. The recovery involves little pain and discomfort and most patients return to work after a period of 7 days. All sutures will be removed in 7 days.
The most common side effect of the surgery is minor swelling and bruising, which subsides in few days. Other potential risks and complications of the surgery are extremely rare, especially in the hands of a qualified surgeon, but include
- Bleeding (hematoma)
- Poor wound healing
- Anesthesia risks
- Possibility of revisional surgery
These risks and others will be fully discussed prior to your consent. It is important that you address all your questions with your surgeon.
They will take care of you
MEET THE TEAM
PETER JFM LOHUIS, MD PHD
BORIS FILIPOVIĆ, MD PHD
IVANA JURJEVIĆ, MD PHD
MARINA MILOŠEVIĆ, MD
FREQUENTLY ASKED QUESTIONS
· Recovery period is usually only few days and you may start doing your daily routines as soon as the following day.
· When complication occur, two things are important – to immediately identify the complication, and to promptly start treatment. Depending on the type of the complication the treatment will defer from secondary surgery, to just reassurance.
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