Temporal aneurysms and migraine surgery.

The present study reports two cases of chronic migraines associated with superficial temporal artery aneurysms. The patients received aneurysm's ligation, with no other surgical maneuvers. In the six months following surgery, both patients were disease-free and did not experience any migraine attacks. Evidence-based medicine ranking: Level V.

Basal cell carcinoma of the scalp: surgical approach and reconstructive options.

INTRODUCTION: Surgical therapy of basal cell carcinomas (BCC) is based on complete excision of the neoplasm and its immediate suitable reconstruction. The aim of this work was to evaluate the possibility of creating a reconstructive algorithm in cases of scalp BCC, depending on the amplitude of the tumor. EVIDENCE ACQUISITION: A literature search was carried out using the databases of PubMed, Scopus and Cochrane. EVIDENCE SYNTHESIS: Based on the experiences reported in the literature, it was possible to structure a decision-making algorithm that summarizes the various steps involved in the choice of the most suitable reconstructive surgical therapy. CONCLUSIONS: The algorithm described we hope will be of reference or help to less experienced reconstructive plastic surgeons.

Active Occipital Motion with Digipressure as Preoperative Screening in Migraine Surgery.

Background: Modern surgical therapy of chronic headaches/migraines is essentially based on the release/neurolysis of extracranial nerves, which, when compressed or inflamed, act as trigger points and, as such, trigger headache attacks. The aim of this article was to describe a novel maneuver we use as an aid in the preoperative planning of occipital trigger sites. Methods: In the period of January 2021-September 2023, we operated on 32 patients (11 men, 21 women, age range: 26-68 years), who underwent migraine surgery for occipital trigger point release. All patients were evaluated using the described preoperative maneuver. In a dedicated card, the levels of tenderness at each point were marked accordingly, differentiating them by intensity as nothing (-), mild (+), medium (++), or high (+++). Patients were then operated on at the points corresponding only to the ++ and +++ signs. Results: At 6-month follow-up, we observed significant improvement (>50%) in 29 patients (91%), with complete recovery in 25 patients (78%). Conclusions: In our experience, the maneuver described, in addition to being very simple, has been shown to have good sensitivity and reproducibility. We therefore recommend its use, especially for those surgeons beginning their practice in this particular area of plastic surgery.

Frontal site surgery for chronic migraine therapy.

BACKGROUND: According to the most current theories, chronic inflammation of some cranial nerves give rise to an inflammatory chain that would result in migraines. As for frontally located attacks, the nerves involved are two (on each side): the supraorbital and the supratrochlear. Surgical treatment includes complete neurolysis of both of these nerves. METHODS: In this work, we describe our experience with this type of surgery. From 2011 to 2022, we treated 98 cases suffering from chronic migraine not responsive to drugs with frontal localization. The results were evaluated through a specific questionnaire three months and one year after surgery. RESULTS: After three months post-surgery, we observed a success rate (reduction of monthly attacks equivalent to or greater than 50%) in 87% of patients (32% complete recovery). These results were essentially confirmed one year after surgery. The rare complications (mainly paresthesias and dysesthesias of the frontal area) have always resolved spontaneously within a few months. CONCLUSION: The surgical approach allowed to obtain good therapeutic results with a low rate of complications.

Temporal surgery for chronic migraine treatment: A minimally-invasive perspective.

•In this paper, we describe our mini-invasive approach for the deactivation of the auriculotemporal nerve in migraine surgery.•After a mean follow-up of 21 months (range, 3-67 months), patients complaining for temporal MH had 83% positive surgical outcome (50% complete MH elimination, 33% significant improvement).•Only rare minor complications are usually reported (eg, oedema, paresthesia hematoma/ecchymosis, and numbness).

Surgical therapy of occipital (Arnold) neuralgia: A case series.

Objective: The idea to treat occipital neuralgia patients with a surgical procedure is relatively recent. The aim of this paper was to describe the surgical techniques and our 12-year experience in this field. Materials and methods: From June 2011 till February 2022 we have performed surgery over 232 patients with occipital neuralgia. Results: The surgical procedure elicited a positive response in 86% of the patients. Conclusions: The described techniques allowed to obtain an high rate of positive results with a minimum percentage of complications.

Scalp reconstruction by tissue expansion: tips and tricks.

BACKGROUND AND AIM: Numerous details regarding preoperative planning of scalp expansion are of the utmost importance for maximizing the results of this procedure. METHODS: The purpose of this paper is to describe the tips and tricks useful for obtaining the best results in scalp expansion. RESULTS: Basic concepts and operative technique are discussed and detailed. CONCLUSIONS: In scalp reconstruction, the use of tissue expansion allows to obtain successful results, Anyhow, it is mandatory to follow some basic rules, dictated by anatomical, technical, and psychological considerations.

An easy and reliable way to preoperatively identify the auriculo-temporal nerve in migraine surgery.

In this paper, we describe a simple and reliable way to preoperatively localize the auriculotemporal nerve in migraine surgery. We measured the correspondence of this cutaneous landmark and the ATN in twelve migraine patients operated at Site V. Our findings demonstrated a very high concordance between the described point and the underlying auriculotemporal nerve. This method might be of some utility in the preoperative planning of Site V Migraine surgery, in the strive of reducing the length of cutaneous incision and the invasiveness of the procedure.

Morphologic vascular anomalies detected during migraine surgery.

Although there is increasing evidence of migraine headaches having extracranial origins, the exact mechanisms underlying the pathogenesis of surgically treated migraines continue to be poorly investigated and described. We studied the microscopic and ultrastructural characteristics of superficial temporal artery (STA) and occipital (OA) artery in the auriculotemporal and great occipital trigger points of migraine patients to determine their possible role in migraine etiopathogenesis. Fifteen biopsies, 10 of STA and 5 from OAs, were collected intraoperatively during migraine surgery and immediately processed for optical and ultramicroscopic analysis. We detected the following anomalies in all the specimens: (a) endothelial damage with internal elastic lamina fragmentation and intimal thickening; (b) marked irregularity in the shape and metachromasia of the vascular smooth muscle cells (VSMCs), separation of cells by abundant extracellular matrix and vacuoles. The electron microscopy analysis confirmed that presumed VSMCs infiltrated the intima layer revealing a consistent shift of VSMCs from contractile to synthetically active phenotypes, endosome-like organelles, multilamellar structures, abundant extracellular vacuoles filled with fine granular material and membranes, and extracellular vesicles in the matrix space surrounding synthetically active cells. Our study revealed specific alterations in the vasculature at the neurovascular bundles of the temporal and occipital trigger sites. These findings are indicative of an active involvement of the arteries in the auriculotemporal and great occipital trigger sites in evoking migraine.

Perforator flaps for vulvar reconstruction: basic principles.

BACKGROUND AND AIM: In vulvar cancer, the standard treatment is radical local excision, with immediate reconstruction. Reconstruction aims to restore anatomy and function of the external female genitalia, facilitating preservation of normal body image, sexual function, and micturition and defecation functions. METHODS: The purpose of this paper is to describe the principles of perforator flaps for vulvar reconstruction. RESULTS: Basic concepts, indications and operative technique are discussed and detailed. CONCLUSIONS: In vulvar reconstruction, the use of perforator flaps is a superior surgical technique when compared to the use of conventional flaps.