Migren ameliyatı

Migren ameliyatı veya migren cerrahisi, kronik migren hastaları için özel olarak geliştirilmiş, belirli tetik noktalarını hedef alan cerrahi bir işlemdir. Bu prosedür, migren ataklarının sıklığını ve şiddetini azaltarak hastanın yaşam kalitesini artırmayı amaçlar.^[1]^[2]^[3]^[4]

Migren ameliyatı, migren ataklarıyla ilişkili belirli sinirlerin ve kasların dekompresyonunu veya modifikasyonunu içerir. Bu tetik noktalarındaki basıncı hafifleterek, prosedür migren ataklarını en aza indirmeye yardımcı olabilir. Amaç, geleneksel tedavilere yanıt vermeyen hastalar için uzun vadeli rahatlama sağlamaktır.

2000 yılında migren ağrısını hafifletmek için sinir dekompresyon tekniklerinin geliştirilmesinin ardından, bu prosedürler kapsamlı bir şekilde incelenmiş ve uygun adaylarda etkili olduğu gösterilmiştir.^[5]^[6]^[7] Migren ameliyatında en sık ele alınan sinirler kafatasının dışında, yüz ve boyunda bulunur ve alındaki supraorbital ve supratrochlear sinirler, şakak bölgesindeki zygomaticotemporal sinir ve auriculotemporal sinirler ile boyun arkasındaki büyük oksipital, küçük oksipital ve üçüncü oksipital sinirlerdir.^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16] Burun boşluğundaki sinir sıkışmasının da migren semptomlarının bir tetikleyicisi olduğu gösterilmiştir.

Endikasyonlar ve hasta seçimi

Migren ameliyatı genellikle daha konservatif tedavilerden fayda görmeyen veya migren tedavisinde kullanılan ilaçların yan etkilerini tolere edemeyen migren hastaları içindir. Uygun hastalar, geçici sinir bloğu sağlamak için lokal anestezi enjeksiyonları kullanılarak taranır. Bazı durumlarda, sinirin geçici olarak dekompresyonunu sağlamak için Botox kullanılabilir.^[17] Sinir bloklarına yanıt veren hastalar, migreni tetikleyen siniri “kapatarak” ağrılarında genellikle geçici de olsa anında bir azalma görürler. Botox enjeksiyonlarının ardından ağrının hafiflemesi ise siniri sıkıştırabilecek olan yakındaki kas dokusunun gevşemesiyle sağlanır. Bu tarama prosedürlerine iyi yanıt veren hastalar, migren ameliyatı için kusursuz derecede uygun adaylar olarak kabul edilirler.^[18]^[19]^[20]^[21]

İşleme Genel Bakış

Hazırlık

Hastaların, sorunsuz bir prosedür için doktorları tarafından sağlanan ameliyat öncesi yönergelere uyması ve belirli ilaçları bırakması gerekebilir.

Anestezi

Ameliyat, genel anestezi veya sedasyon eşliğinde lokal anestezi altında yapılır ve ağrısız bir deneyim sağlar.

Prosedür

Cerrah, migren tetikleyicileriyle bağlantılı belirli sinir bölgelerini hedefler, bu noktalardaki basıncı hafifletir ve migren sıklığını ile yoğunluğunu azaltır.

Sonuçlar

Migren ameliyatı, baş ağrısının şiddetini ve sıklığını önemli ölçüde azaltabilir. Ancak, sonuçlar kişiden kişiye değişir ve uzun vadeli başarı, hastanın bireysel durumuna ve ameliyat sonrası bakıma uyumuna bağlıdır.

Başlangıçta deneysel bir ameliyat olarak düşünülse de, migren ameliyatının faydaları günümüzde iyi bir şekilde belgelenmiştir. Takip verileri, migren ameliyatı geçiren hastaların %88'inin 5 yıl sonra prosedüre olumlu yanıt verdiğini göstermiştir. Hastaların %29'unun migren hastalığından tamamen kurtulduğu görülürken, %59'u migren ameliyatı geçirdikten 5 yıl sonra ağrı ve semptomlarında önemli bir azalma olduğunu bildirmiştir. Migren ameliyatı geçiren hastaların %12'si 5 yıl sonra semptomlarında herhangi bir değişiklik olmadığını bildirmiştir.^[22]^[23]^[24]^[25]

Migren ameliyatı ayrıca sosyoekonomik bağlamda incelenmiş ve migren hastalığıyla ilişkili doğrudan ve dolaylı maliyetleri azalttığı gösterilmiştir. Migren ameliyatı sonrası bu tür maliyetlerin hasta başına yıllık ortalama 3.949 dolar azaldığı gösterilmiştir.^[26]

Kaynakça

^ Ducic I, Moriarty M, Al-Attar A (March 2009). "Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches". Plastic and Reconstructive Surgery. 123 (3): 859-63; discussion 864. doi:10.1097/prs.0b013e318199f080. PMID 19319048.
^ Janis JE, Hatef DA, Reece EM, McCluskey PD, Schaub TA, Guyuron B (December 2010). "Neurovascular compression of the greater occipital nerve: implications for migraine headaches". Plastic and Reconstructive Surgery. 126 (6): 1996-2001. doi:10.1097/prs.0b013e3181ef8c6b. PMID 21124138.
^ Ascha M, Kurlander DE, Sattar A, Gatherwright J, Guyuron B (June 2017). "In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV)". Plastic and Reconstructive Surgery. 139 (6): 1333e-1342e. doi:10.1097/prs.0000000000003395. PMID 28538577.
^ Mosser SW, Guyuron B, Janis JE, Rohrich RJ (February 2004). "The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches". Plastic and Reconstructive Surgery. 113 (2): 693-7; discussion 698-700. doi:10.1097/01.prs.0000101502.22727.5d. PMID 14758238.
^ Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S (August 2009). "A placebo-controlled surgical trial of the treatment of migraine headaches". Plastic and Reconstructive Surgery. 124 (2): 461-8. doi:10.1097/prs.0b013e3181adcf6a. PMID 19644260.
^ Janis JE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B (October 2014). "A review of current evidence in the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 134 (4 Suppl 2): 131S-41S. doi:10.1097/prs.0000000000000661. PMID 25254996.
^ Guyuron B, Kriegler JS, Davis J, Amini SB (February 2011). "Five-year outcome of surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 127 (2): 603-8. doi:10.1097/prs.0b013e3181fed456. PMID 20966820.
^ Lee M, Brown M, Chepla K, Okada H, Gatherwright J, Totonchi A, Alleyne B, Zwiebel S, Kurlander D, Guyuron B (December 2013). "An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 132 (6): 1551-6. doi:10.1097/prs.0b013e3182a80721. PMID 24005368.
^ Ducic I, Moriarty M, Al-Attar A (March 2009). "Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches". Plastic and Reconstructive Surgery. 123 (3): 859-63; discussion 864. doi:10.1097/prs.0b013e318199f080. PMID 19319048.
^ Janis JE, Hatef DA, Hagan R, Schaub T, Liu JH, Thakar H, Bolden KM, Heller JB, Kurkjian TJ (April 2013). "Anatomy of the supratrochlear nerve: implications for the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 131 (4): 743-50. doi:10.1097/prs.0b013e3182818b0c. PMID 23249981.
^ Ascha M, Kurlander DE, Sattar A, Gatherwright J, Guyuron B (June 2017). "In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV)". Plastic and Reconstructive Surgery. 139 (6): 1333e-1342e. doi:10.1097/prs.0000000000003395. PMID 28538577.
^ Janis JE, Hatef DA, Reece EM, McCluskey PD, Schaub TA, Guyuron B (December 2010). "Neurovascular compression of the greater occipital nerve: implications for migraine headaches". Plastic and Reconstructive Surgery. 126 (6): 1996-2001. doi:10.1097/prs.0b013e3181ef8c6b. PMID 21124138.
^ Mosser SW, Guyuron B, Janis JE, Rohrich RJ (February 2004). "The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches". Plastic and Reconstructive Surgery. 113 (2): 693-7; discussion 698-700. doi:10.1097/01.prs.0000101502.22727.5d. PMID 14758238.
^ Chim H, Okada HC, Brown MS, Alleyne B, Liu MT, Zwiebel S, Guyuron B (August 2012). "The auriculotemporal nerve in etiology of migraine headaches: compression points and anatomical variations". Plastic and Reconstructive Surgery. 130 (2): 336-41. doi:10.1097/prs.0b013e3182589dd5. PMID 22842409.
^ Dash KS, Janis JE, Guyuron B (May 2005). "The lesser and third occipital nerves and migraine headaches". Plastic and Reconstructive Surgery. 115 (6): 1752-8; discussion 1759-60. doi:10.1097/01.prs.0000161679.26890.ee. PMID 15861086.
^ Janis JE, Hatef DA, Thakar H, Reece EM, McCluskey PD, Schaub TA, Theivagt C, Guyuron B (August 2010). "The zygomaticotemporal branch of the trigeminal nerve: Part II. Anatomical variations". Plastic and Reconstructive Surgery. 126 (2): 435-42. doi:10.1097/prs.0b013e3181e094d7. PMID 20375758.
^ Elhawary, Hassan; Kavanagh, Kaitlin; Janis, Jeffrey E. (5 Mayıs 2024). "The Positive and Negative Predictive Value of Targeted Diagnostic Botox Injection in Nerve Decompression Migraine Surgery". Plastic and Reconstructive Surgery (İngilizce). 153 (5): 1133-1140. doi:10.1097/PRS.0000000000010806. ISSN 0032-1052. PMID 37285182.
^ Lee M, Monson MA, Liu MT, Reed D, Guyuron B (April 2013). "Positive botulinum toxin type a response is a prognosticator for migraine surgery success". Plastic and Reconstructive Surgery. 131 (4): 751-7. doi:10.1097/prs.0b013e3182818b7f. PMID 23542247.
^ Janis JE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B (October 2014). "A review of current evidence in the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 134 (4 Suppl 2): 131S-41S. doi:10.1097/prs.0000000000000661. PMID 25254996.
^ Guyuron B, Nahabet E, Khansa I, Reed D, Janis JE (October 2015). "The Current Means for Detection of Migraine Headache Trigger Sites". Plastic and Reconstructive Surgery. 136 (4): 860-7. doi:10.1097/prs.0000000000001572. PMID 26397259.
^ Janis JE, Dhanik A, Howard JH (July 2011). "Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression". Plastic and Reconstructive Surgery. 128 (1): 123-31. doi:10.1097/prs.0b013e3182173d64. PMID 21701329.
^ Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S (August 2009). "A placebo-controlled surgical trial of the treatment of migraine headaches". Plastic and Reconstructive Surgery. 124 (2): 461-8. doi:10.1097/prs.0b013e3181adcf6a. PMID 19644260.
^ Janis JE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B (October 2014). "A review of current evidence in the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 134 (4 Suppl 2): 131S-41S. doi:10.1097/prs.0000000000000661. PMID 25254996.
^ Guyuron B, Kriegler JS, Davis J, Amini SB (February 2011). "Five-year outcome of surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 127 (2): 603-8. doi:10.1097/prs.0b013e3181fed456. PMID 20966820.
^ Guyuron B, Lineberry K, Nahabet EH (June 2015). "A retrospective review of the outcomes of migraine surgery in the adolescent population". Plastic and Reconstructive Surgery. 135 (6): 1700-5. doi:10.1097/prs.0000000000001270. PMID 26017602.
^ Faber C, Garcia RM, Davis J, Guyuron B (April 2012). "A socioeconomic analysis of surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 129 (4): 871-7. doi:10.1097/prs.0b013e318244217a. PMID 22183497.

[:0-1] Ducic I, Moriarty M, Al-Attar A (March 2009). "Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches". Plastic and Reconstructive Surgery. 123 (3): 859-63; discussion 864. doi:10.1097/prs.0b013e318199f080. PMID 19319048.

[:1-2] Janis JE, Hatef DA, Reece EM, McCluskey PD, Schaub TA, Guyuron B (December 2010). "Neurovascular compression of the greater occipital nerve: implications for migraine headaches". Plastic and Reconstructive Surgery. 126 (6): 1996-2001. doi:10.1097/prs.0b013e3181ef8c6b. PMID 21124138.

[:2-3] Ascha M, Kurlander DE, Sattar A, Gatherwright J, Guyuron B (June 2017). "In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV)". Plastic and Reconstructive Surgery. 139 (6): 1333e-1342e. doi:10.1097/prs.0000000000003395. PMID 28538577.

[:3-4] Mosser SW, Guyuron B, Janis JE, Rohrich RJ (February 2004). "The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches". Plastic and Reconstructive Surgery. 113 (2): 693-7; discussion 698-700. doi:10.1097/01.prs.0000101502.22727.5d. PMID 14758238.

[:52-5] Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S (August 2009). "A placebo-controlled surgical trial of the treatment of migraine headaches". Plastic and Reconstructive Surgery. 124 (2): 461-8. doi:10.1097/prs.0b013e3181adcf6a. PMID 19644260.

[:42-6] Janis JE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B (October 2014). "A review of current evidence in the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 134 (4 Suppl 2): 131S-41S. doi:10.1097/prs.0000000000000661. PMID 25254996.

[:62-7] Guyuron B, Kriegler JS, Davis J, Amini SB (February 2011). "Five-year outcome of surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 127 (2): 603-8. doi:10.1097/prs.0b013e3181fed456. PMID 20966820.

[:7-8] Lee M, Brown M, Chepla K, Okada H, Gatherwright J, Totonchi A, Alleyne B, Zwiebel S, Kurlander D, Guyuron B (December 2013). "An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 132 (6): 1551-6. doi:10.1097/prs.0b013e3182a80721. PMID 24005368.

[:02-9] Ducic I, Moriarty M, Al-Attar A (March 2009). "Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches". Plastic and Reconstructive Surgery. 123 (3): 859-63; discussion 864. doi:10.1097/prs.0b013e318199f080. PMID 19319048.

[10] Janis JE, Hatef DA, Hagan R, Schaub T, Liu JH, Thakar H, Bolden KM, Heller JB, Kurkjian TJ (April 2013). "Anatomy of the supratrochlear nerve: implications for the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 131 (4): 743-50. doi:10.1097/prs.0b013e3182818b0c. PMID 23249981.

[:22-11] Ascha M, Kurlander DE, Sattar A, Gatherwright J, Guyuron B (June 2017). "In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV)". Plastic and Reconstructive Surgery. 139 (6): 1333e-1342e. doi:10.1097/prs.0000000000003395. PMID 28538577.

[:12-12] Janis JE, Hatef DA, Reece EM, McCluskey PD, Schaub TA, Guyuron B (December 2010). "Neurovascular compression of the greater occipital nerve: implications for migraine headaches". Plastic and Reconstructive Surgery. 126 (6): 1996-2001. doi:10.1097/prs.0b013e3181ef8c6b. PMID 21124138.

[:32-13] Mosser SW, Guyuron B, Janis JE, Rohrich RJ (February 2004). "The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches". Plastic and Reconstructive Surgery. 113 (2): 693-7; discussion 698-700. doi:10.1097/01.prs.0000101502.22727.5d. PMID 14758238.

[14] Chim H, Okada HC, Brown MS, Alleyne B, Liu MT, Zwiebel S, Guyuron B (August 2012). "The auriculotemporal nerve in etiology of migraine headaches: compression points and anatomical variations". Plastic and Reconstructive Surgery. 130 (2): 336-41. doi:10.1097/prs.0b013e3182589dd5. PMID 22842409.

[:8-15] Dash KS, Janis JE, Guyuron B (May 2005). "The lesser and third occipital nerves and migraine headaches". Plastic and Reconstructive Surgery. 115 (6): 1752-8; discussion 1759-60. doi:10.1097/01.prs.0000161679.26890.ee. PMID 15861086.

[16] Janis JE, Hatef DA, Thakar H, Reece EM, McCluskey PD, Schaub TA, Theivagt C, Guyuron B (August 2010). "The zygomaticotemporal branch of the trigeminal nerve: Part II. Anatomical variations". Plastic and Reconstructive Surgery. 126 (2): 435-42. doi:10.1097/prs.0b013e3181e094d7. PMID 20375758.

[17] Elhawary, Hassan; Kavanagh, Kaitlin; Janis, Jeffrey E. (5 Mayıs 2024). "The Positive and Negative Predictive Value of Targeted Diagnostic Botox Injection in Nerve Decompression Migraine Surgery". Plastic and Reconstructive Surgery (İngilizce). 153 (5): 1133-1140. doi:10.1097/PRS.0000000000010806. ISSN 0032-1052. PMID 37285182.

[18] Lee M, Monson MA, Liu MT, Reed D, Guyuron B (April 2013). "Positive botulinum toxin type a response is a prognosticator for migraine surgery success". Plastic and Reconstructive Surgery. 131 (4): 751-7. doi:10.1097/prs.0b013e3182818b7f. PMID 23542247.

[:43-19] Janis JE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B (October 2014). "A review of current evidence in the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 134 (4 Suppl 2): 131S-41S. doi:10.1097/prs.0000000000000661. PMID 25254996.

[20] Guyuron B, Nahabet E, Khansa I, Reed D, Janis JE (October 2015). "The Current Means for Detection of Migraine Headache Trigger Sites". Plastic and Reconstructive Surgery. 136 (4): 860-7. doi:10.1097/prs.0000000000001572. PMID 26397259.

[21] Janis JE, Dhanik A, Howard JH (July 2011). "Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression". Plastic and Reconstructive Surgery. 128 (1): 123-31. doi:10.1097/prs.0b013e3182173d64. PMID 21701329.

[:5-22] Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S (August 2009). "A placebo-controlled surgical trial of the treatment of migraine headaches". Plastic and Reconstructive Surgery. 124 (2): 461-8. doi:10.1097/prs.0b013e3181adcf6a. PMID 19644260.

[:4-23] Janis JE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B (October 2014). "A review of current evidence in the surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 134 (4 Suppl 2): 131S-41S. doi:10.1097/prs.0000000000000661. PMID 25254996.

[:6-24] Guyuron B, Kriegler JS, Davis J, Amini SB (February 2011). "Five-year outcome of surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 127 (2): 603-8. doi:10.1097/prs.0b013e3181fed456. PMID 20966820.

[25] Guyuron B, Lineberry K, Nahabet EH (June 2015). "A retrospective review of the outcomes of migraine surgery in the adolescent population". Plastic and Reconstructive Surgery. 135 (6): 1700-5. doi:10.1097/prs.0000000000001270. PMID 26017602.

[26] Faber C, Garcia RM, Davis J, Guyuron B (April 2012). "A socioeconomic analysis of surgical treatment of migraine headaches". Plastic and Reconstructive Surgery. 129 (4): 871-7. doi:10.1097/prs.0b013e318244217a. PMID 22183497.

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