Minimally Invasive Surgical Treatment of Migraine

Migraine headache (MH) is a very common disorder affecting 10–12% of the world’s adult population. The first line therapy for migraine is usually a combination of conservative treatments but some patients seem to be refractory. For this group of patients, the minimally invasive surgical treatment of migraine might offer a solution. Migraine is usually caused by extracranial sensitive nerve compression due vascular, fascial or muscular structures nearby. The aim of migraine surgery is to relieve such compression at specific trigger points located in the occipital, temporal and frontal regions. From June 2011 until July 2019, we performed MH decompression surgeries in over 269 patients with either frontal, occipital, or temporal migraine trigger sites. In the occipital and temporal areas, nerve decompression was achieved by occipital and superficial temporal artery ligation, respectively. In patients suffering from frontal headache we performed both endoscopic nerve decompression and transpalpebral decompression. Among patient suffering from occipital migraine, 95% of them showed improvement of their condition, with 86% reporting complete relief. As concern temporal migraine, positive outcome was achieved in 83% of the patients (50% complete elimination and 33% partial improvement). In patient suffering from frontal migraine, positive results were observed in 94% of the patients (32% complete elimination, 62% partial improvement). Migraine is a common and debilitating condition that can be treated successfully with minimally invasive surgical procedure especially for those patients non-responding to medical therapies

Surgical Therapy of Temporal Triggered Migraine Headache

Background:. The auriculotemporal and zygomaticotemporal nerves are the 2 primary trigger points in the temporal area of migraine headache. Different surgical approaches are described in literature, either open or endoscopic ones. Methods:. We described and delineated the currently adopted strategies to treat temporal trigger points in migraine headache. Furthermore, we reported our personal experience in the field. Results:. Regardless of the type of approach, outcomes observed were similar and ranged from 89% to 67% elimination / >50% reduction rates. All procedures are minimally invasive and only minor complications are reported, with an incidence ranging from 1% to 5%. Conclusions:. Just like upper limb compressive neuropathies, migraine headache is believed to be caused by chronic compression of peripheral nerves (ie, the terminal branches of trigeminal nerve) caused by surrounding structures (eg, muscles, vessels, and fascial bands) the removal of which eventually results in improvement or elimination of migraine attacks. Particular attention should be paid to the close nerve/artery relationship often described in anatomical studies and clinical reports

Cardiovascular implantable electronic device infection: delayed vs standard FDG PET-CT imaging

Positron emission tomography-computed tomography (PET-CT) with (18)F-fluorodeoxyglucose (FDG) has emerged as a rapidly evolving diagnostic tool for infectious diseases. However, the optimal imaging time in this clinical setting is not clear yet. The aim of this study is to investigate whether delayed (3 hours) FDG PET-CT could increase the diagnostic accuracy of this technique compared to standard (1 hour) imaging in the detection of septic foci involving the pocket and/or pacing leads in patients with suspected cardiovascular implantable electronic device (CIED) infection scheduled for device removal. METHODS AND RESULTS: Twenty-seven patients underwent standard and delayed imaging. PET-CT results were compared to bacteriological cultures after CIED removal. Fifteen controls free of infection underwent PET-CT imaging as part of investigation of malignancy. The diagnostic accuracy of delayed imaging was significantly higher than 1-hour scan for lead infection (70% vs 51%, P = .024). No significant difference was found between standard and delayed diagnostic accuracy for pocket or device infection. Semi-quantitative analysis showed that mean pocket and lead target-to-background ratio were significantly higher on delayed compared to standard imaging (3.7 \ub1 1.9 vs 1.6 \ub1 1.1, P = .0002; 3.0 \ub1 1.3 vs 0.7 \ub1 1.0, P = .01). CONCLUSIONS: Delayed FDG PET-CT imaging should be considered at least in patients with negative 1-hour scan and founded suspicion of pacing lead infection