Radiologic Evaluation of Exiting Points of Supraorbital Region Neurovascular Bundles in Patients With Migraine

Abstract

Purpose: To reveal the presence and nature of exiting points of supraorbital region neurovascular structures and determine the distances of those structures to midline with computed tomography images by taking into account gender and sides in patients with migraine. Methods: The study was conducted retrospectively on computed tomography images of 70 migraine and 70 control patients with a mean age of 39.5 ± 13.8 years (range: 18–80). Presence and nature (foramen or notch) of exiting points of neurovascular structures in terms of side and gender in both groups, and the distances of these structures to the midline of the face were evaluated. Results: In migraine and control groups, the most commonly seen structure was single notch. Coexistence of foramen and notch was statistically significant in migraine and female migraine groups than control and female control groups (P < 0.05). Bilateral presence of supraorbital structure was 51.4% in migraine group and 64.3% in control group patients. In all cases, foramen-midline distance was statistically significant longer than the notch-midline distance (P < 0.05). In migraine patients, no statistically significant difference was detected regarding distances of foramen and notch to midline in terms of side and gender. Conclusion: Consideration of variable presence and location of the supraorbital notch and foramen, analysis of computed tomography scan might be beneficial in preoperative planning of foraminotomy and fascial band release in adult migraine patients to prevent intraoperative complications. Also, coexistence is more frequent on left side in migraine patients that might cause overlooking those structures during surgery.

Computed Tomography Evaluation of Frontal Sinus Volume in Migraine Patients

“…The distances of the foramen and notch from the midline vary among individuals. 19 Our study observed that the foramen midline distance was longer than the notch midline distance, consistent with findings in the literatüre. 4,19 Therefore, evaluation of migraine patients with CT before the intervention, especially in those whose pain originates in the frontal region, helps to necessitate careful preoperative planning to prevent neurovascular injury.…”

“…Anatomic variations of the paranasal region in migraine patients were detected in our prior study, where the presence of Haller cells was more common in migraine patients than in control subjects 18 . In addition, although the most common structure in the supraorbital region in migraine patients is a single supraorbital notch, the frequency of absence of foramens/notches and single foramens is around 30% in other migraine studies 19 …”

“…18 In addition, although the most common structure in the supraorbital region in migraine patients is a single supraorbital notch, the frequency of absence of foramens/notches and single foramens is around 30% in other migraine studies. 19 There is a contradiction regarding the effects of paranasal sinus volumes on headaches in the literature. Several authors have suggested that low FSVs may be related to the etiology of rhinogenic headaches, 20,21 while others have suggested that enlarged frontal sinuses are associated with rhinogenic headaches.…”

Anatomical variations and abnormalities of the maxillary region and clinical implications: A systematic review and metaanalysis

“…The first observed that in some cases there is a relation between the presence of the variation and the incidence of migraine appearance. [ 64 ] The second reported a case of headache and acute loss of sight in a patient with retrobulbar optic neuropathy and hemianopsia in the left eye, secondary to left Sphenoethmoidal sinusitis with the presence of inflammation of the Onodi Cells. [ 65 ]…”

“…Bakoń, 2009 [64] Patients Thickening of the MS mucosa was found in 50% of patients, a septum in the MS was present in 19.4% of patients, and pneumatization of the middle ethmoid cells was observed in 67.5% of patients. The pneumatization of the middle ethmoid cells was presented bilaterally in 43.2% of cases, while in 12.3% of cases it was located on the left side, and in 13.0% of cases it was located on the right side.…”