Minimally Invasive Endoscopic Surgical Treatment of Headache

Surgical Therapy of Migraine and Tension-Type Headache

“…In 2011, Guyuron et al published a study examining the longterm benefits of migraine surgery where it was reported an 88% success rate after a 5-year follow-up (29% completely healed; 59% gained improvement; 12% did not show any change) [8]. Other independent groups reported similar findings using Guyuron's protocols, demonstrating the effectiveness of the procedure and the reproducibility of the results [5,[12][13][14][15].…”

“…This is due to the presence of muscular and fascial entrapments and also because of their interaction with the vascular structures [3,5,6,[12][13][14][15].…”

“…Two distinct surgical instruments, an endoscope and a dissector, are generally used. In an effort to reduce the invasiveness of the current endoscopic techniques, we described our minimally invasive, endoscopic selective myotomy technique with a single access, performed with a specifically modified endoscope (Karl Storz, Tuttlingen, Germany) and without the need for general anesthesia [12][13][14][15]. With the patient supine and the head in a neutral position, frontal trigger nerves are located.…”

“…As regards our experience, when trigger site is identified in the LON, a 4-cm-long lateral occipital incision is performed, followed by the dissection of occipital, trapezius, and a portion of sternocleidomastoid muscles, thus freeing the nerve. If patients present both trigger points, an 8-cm-long medial incision is made and dissection of all abovementioned muscles and vessels (occipital arteries) and isolation of both nerves are performed [15].…”

“…For this reason commonly the auriculotemporal nerve decompression is performed in conjunction with the zygomaticotemporal decompression [5,6]. We report the endoscopic surgical techniques to decompression-avulsion of the auriculotemporal nerve [5,6,15]. The point of maximal tenderness is marked, and Doppler findings to determinate vessel location may be used to avoid injury to the surrounding nerves or difficulty to place the endoscopic access devices.…”