The importance of surgical maneuvers during treatment of frontal migraines (site I): A prospective, randomized cohort study evaluating foraminotomy/ fasciotomy, myectomy, and arterectomy

Background: The current prospective, blinded, randomized cohort study aims to delineate the relative contribution of different surgical treatments for frontal migraines. Methods: Patients undergoing migraine surgery in the frontal region (site I) were prospectively enrolled and blindly randomized into one of the following four groups: (1) myectomy alone, (2) myectomy and foraminotomy/fasciotomy, (3) myectomy and arterectomy, and (4) foraminotomy/fasciotomy alone. Pre- and post-surgical migraine headache severity, duration, Migraine Headache Index (MHI) score, and migraine-free days (MFDs) were obtained. Results: Thirteen patients agreed to participate in the study. For all patients, the mean pre- and post-operative MHI scores demonstrated a significant improvement from 52.6 (3.8-85) to 4.7 (0-21.3) (p = 0.0001). Thirty-one percent of patients required a site I revision that included an arterectomy. Patients who had an arterectomy at their initial surgery demonstrated statistically significant improvement in both frequency (12 vs. 6.11; p = 0.02) and MHI scores (51.71 vs. 5.55; p < 0.01). Arterectomy patients also demonstrated a significant improvement in the number of MFDs following surgery, from 18 to 24 MFDs (p = 0.021). Those patients not undergoing arterectomy demonstrated statistically significant improvements in the number of MFDs after their initial surgery (13.25 MFDs, p = 0.01), but the improvement was significantly less when compared to the arterectomy group (13.25 vs. 24 MFDs; p = 0.026). Following revision arterectomy, both groups had statistically equivalent improvement in MFDs (20.75 vs. 24 MFDs; p = 0.178). Conclusions: These findings suggest that arterectomy is necessary for successful treatment of frontal migraines (site I). (c) 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.