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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Endoscopic sinonasal surgery (part1)
        
(Message started by: cluster on Dec 10^th, 2006, 2:29pm)

Title: Endoscopic sinonasal surgery (part1)
Post by cluster on Dec 10^th, 2006, 2:29pm

Dear all,

sorry for re-posting, but I think this posting got "lost" when the other thread switched pages.

(See http://www.clusterheadaches.com/cgi-bin/yabb/YaBB.cgi?board=chspecific;action=display;num=1164723998;start=0#0 for the other thread.)

Valde's posting is the third positive patients report I have read about nasal surgery so far.

Has anybody else had good or bad experience with nasal surgery?

Could it be, that there is a disease with cluster like symptoms which can be cured by nose surgery?

Some "scientific" information (PubMed abstracts):

Rhinology. 1997 Sep;35(3):98-102. Related Articles, Links

Endoscopic sinonasal surgery in the management of primary headaches.

Clerico DM, Evan K, Montgomery L, Lanza DC, Grabo D.

Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, USA.

Primary headaches (migraine, cluster, tension-type) are common disorders thought to be unrelated to nasal and sinus abnormalities. We present data on 19 patients with refractory primary headaches in the absence of significant sinus symptoms. The majority of patients responded with decreased pain to office application of nasal anaesthesia. A high prevalence of sinonasal abnormalities was found on coronal CT scans. Seventy-nine per cent responded with either decreased pain severity or headache frequency after endoscopic sinonasal surgery. We discuss possible underlying mechanisms to explain these findings.

PMID: 9403937 [PubMed - indexed for MEDLINE]

Laryngorhinootologie. 1996 Jul;75(7):392-6.

[3-year follow-up after endonasal microscopic paranasal sinus surgery in migraine and cluster headache]

[Article in German]

Welge-Lussen A, Hauser R, Probst R.

HNO-Universitatsklinik, Basel, Schweiz.

BACKGROUND: Migraine and cluster headache can both be triggered by sensitive intranasal areas. METHODS: Endoscopic nasal surgery was performed in 20 patients with chronic migraine without aura or cluster headaches that were refractory to other forms of treatment for a mean period of 18 years (range of 1-45 years). The selected patients showed clinical and radiographic evidence of contact between the middle turbinate and the nasal septum. All patients experienced immediate relief of pain following topical application of cocaine to the presumable triggering area. Five patients with cluster headache and 15 patients with migraine were treated. RESULTS: All patients with cluster headache were free of symptoms after surgical intervention and for a mean follow-up period of three years. Six of the 15 patients with migraine were completely free of symptoms after a mean follow-up period of three years; five had improved more than 50% in the duration and frequency of their attacks. Treatment was unsuccessful in four patients. CONCLUSION: This trial established a likely relationship between nasal trigger areas and cluster headache through the trigeminovascular system and a possible relationship to some type of migraine without aura.

PMID: 8924166 [PubMed - indexed for MEDLINE]

Ital J Neurol Sci. 1995 Nov;16(8 Suppl):49-55. Related Articles, Links

Pathogenesis and surgical treatment of neurovascular primary headaches.

Novak VJ.

Clinica Villa im Park Rothrist, Lucerna, Svizzera.

The "neurovascular primary headaches" are syndromes also pertinent to otorhinolaringology when CT demonstrates a reduced volume of the "ethmoidosphenoidal subcribriform chamber" according to the endo-exocranial hemoangiokinetics of this area. It is emphasized that in drug-resistant headaches recovery or consistent definitive improvement can be achieved only after surgical correction of certain anatomical parameters (P. Bonaccorsi, V.J. Novak, S. Hoover). Bonaccorsi and Novak independently identified the actual pathophysiologic mechanism and trigger zone ("dysmorphism") for various types of neurovascular primary headaches. Patients (n = 446) with various types of headaches (migraine, cluster headache and so-called idiopathic or primary headaches) were operated upon between 1973 and 1994. Septal correction, resection of the middle and superior concha, ethmoidectomy, and sphenoidectomy on the corresponding headache side or occasionally on both sides were carried out. Most patients (356, 80%) were asymptomatic postoperatively, 45 (10%) had a sensation of pressure in the head on rare occasions but no further migraine, and 45 (10%) continued to experience headache that occurred only rarely and was mild and of short duration. The overall success rate was 90%. For cluster headache in 20 patients, we observed the following postoperative results: 19 cured (98%), 1 improved (2%).

PMID: 8751189 [PubMed - indexed for MEDLINE]

(part 1)

Title: Re: Endoscopic sinonasal surgery (part2)
Post by cluster on Dec 10^th, 2006, 2:32pm

(part 2)

Laryngoscope. 2003 Dec;113(12):2151-6.

Endonasal surgery for contact point headaches: a 10-year longitudinal study.

Welge-Luessen A, Hauser R, Schmid N, Kappos L, Probst R.

Department of Otorhinolaryngology, University of Basel, Kantonsspital, Petersgraben 4, CH-4031 Basel, Switzerland. awelge@uhbs.ch

OBJECTIVE: Some migraine and cluster headaches may be triggered by stimulation of intranasal contact points via the trigeminovascular system. Endonasal surgery is successful in some patients, but long-term outcomes have not been reported. STUDY DESIGN: Prospective. METHODS: This investigation included 20 patients with a mean 18-year history of refractory cluster or migraine headaches who were selected for surgery. All had endoscopically visible endonasal contact as well as a positive preoperative cocaine test result. Changes in pain severity and frequency and duration of headache attacks were statistically rated using a MANOVA. Follow-up averaged 112 months. RESULTS: Almost 10 years after surgery, six patients remained completely free of pain, seven had significant symptom improvement, and seven received no benefit from surgery (65% improvement). Two patients had been free of all symptoms for 7 and 8 years, respectively, before complaints returned. CONCLUSION: Our data suggest that some patients with refractory headaches and endonasal contact areas benefit from surgery, thereby supporting the existence of a connection between the two. Even though it is clear that surgery should be considered only if all other treatments have failed, a success rate of 65% over almost 10 years justifies evaluation of this option. Preoperative patient selection remains crucial and warrants further investigation.

PMID: 14660919 [PubMed - indexed for MEDLINE]

Ital J Neurol Sci. 1995 Nov;16(8 Suppl):69-100.

[Decompressive neurovascular nose and skull-base surgery in primary headache with a rhinogenic trigger]

[Article in Italian]

Bonaccorsi P.

Sezione Chirurgica Cefalee, Casa di Cura Piacenza.

The therapeutical results such as recoveries or substantial improvements obtained by neurovascular decompressive functional morpho-corrective rhino-skull base surgery on 2124 cases of primary headaches (migraine with aura, migraine without aura, cluster headache, chronic paroxysmal hemicrania, tension-type headache) obliges a thorough review of the classical chapter on "rhinogenous headaches" (Bonaccorsi, Novak, Blondiau, Bisschop, Hoover, Clerico). In fact all those headaches seemingly "primary", but having a "central-peripheral" etiopathogenesis proved by a well documented (CT) volumetric reduction of "ethmoidosphenoidal subcribriform chamber" according to hemoangiokinetics purposes of endo-exocranial anastomotic circulation of this area, should be included in the chapter of "rhinogenous headaches". This endo-exocranial anastomotic circulation is considered a "functional unit" owing to the continuity of rhino-ophthalmic-encephalic trigeminal-vegetative and vascular circuits (Hannerz, Hardebo, Moskowitz). These morphological abnormalities of the rhino-skull base osteo-vascular-mucous structures acquire physio-pathological significance only in patients with "low pain threshold and elevated central integrative capability", modulated and timed by the neurogenic biorhythms. It is described the surgery of rhino-skull base by "neurovascular decompressive septo-ethmoidosphenoidectomy" procedure, either conservative or radical till the III grade monolateral with trigeminal and vegetative selective neurotomy that permits to save olfaction and to remove even the controlateral pain decompressing the circulation and eliminating stasis even on the opposite side. Further, it is emphasized that the neurological deficit or central irritative symptomatology (visual aura, sensory-motor paresis, epilepsy) disappears after surgical removal of the "peripheral rhinogenous trigger". It demonstrates a cause and effect relationship that is the central peripheral functional interdependence, even if it's included in the neuro-transmissive, biochemical, neuro-endocrine, constitutional background which is controlled by the psychical, vegetative and dysnociceptive biorhythms.

Publication Types:
Review

PMID: 8751191 [PubMed - indexed for MEDLINE]

See also:

http://www.vj-novak.ch/ (English text at bottom of page)
http://www.vj-novak.ch/publish_2.html

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=401820

Old CH.com thread (could not find newer threads on this subject):
http://www.clusterheadaches.com/cgi-bin/yabb/YaBB.cgi?board=medsarchive2003;action=display;num=1066335835

On german CH MB's I found not much about this, but two positive reports and a comment from Ueli dated November 2000.

German language links:

http://f15.parsimony.net/forum24836/messages/1280.htm

http://f15.parsimony.net/forum24836/messages/11213.htm

http://www.forumromanum.de/member/forum/forum.php?action=std_show&entryid=1096792683&USER=user_42304&threadid=2

Looking forward to reading your replies!

Painfree times!
Friedrich

Title: Re: Endoscopic sinonasal surgery (part1)
Post by CynthiaB on Dec 10^th, 2006, 9:19pm

I didn't lose my copy of it. I think it's still in file 13.

Title: Re: Endoscopic sinonasal surgery (part2)
Post by georgej on Dec 11^th, 2006, 12:16am

on 12/10/06 at 14:32:09, cluster wrote:

Almost 10 years after surgery, six patients remained completely free of pain, seven had significant symptom improvement, and seven received no benefit from surgery (65% improvement). Two patients had been free of all symptoms for 7 and 8 years, respectively, before complaints returned.

How does this compare to spontaneous remission in a control population?

Perhaps I'm merely ignorant, but I don't see how a (poorly defined) "trigger point" being set off in the sinuses can cause massive stimulation of the trigeminal nerve across the face and deep into the head, swelling of blood vessels to twenty times their normal size, sweating, ganglion lumps down the back of the neck, abnormal functioning of the hypothalamus deep inside the brain, seasonal and circadian onset, and any number of other far-reaching physiological consequences.

Until I can understand how that might happen, what mechanism might produce a flash flood of consequences by poking a spot inside the nose, I've got to say that I just don't buy it--it fails to convince.

I'm willing to concede there may be some sinus-related syndrome that superficially resembles CH in some respects that may be relieved by sinus surgery, but whatever it is, it isn't CH.

Best wishes,

George

Title: Mucosal contact point headache
Post by cluster on Feb 19^th, 2007, 10:45am

Hello George,

thank you very much for your answer.

I think some of us clusterheads have had useless, unsuccessful and painful sinus surgery which in the end did not help against cluster headache.

That is why I am suprised about these scientific reports and the "success rate" they claim to have. In the meantime I have googled a bit further: Actually there is an entity called "Mucosal contact point headache" in the International Headache Society's Classification, please see:

http://ihs-classification.org/en/02_klassifikation/05_anhang/11.05.01_anhang.html

Perhaps the patients in the above reports did not have CH (or migraine) at all, but "Mucosal contact point headache" ? Maybe mucosal contact point headache can have cluster headache alike symptoms?

The patients in the above reports did not respond to standard medical treatment ("refractory primary headaches".)

I think it could be worthwhile for some of us "clusterheads" to have this checked, if Verapamil, Lithium, Oxygen, Imitrex etc. fail to help.

Regards and painfree wishes,
Friedrich

Title: Re: Endoscopic sinonasal surgery (part1)
Post by JeffB on Feb 19^th, 2007, 11:58am

I'll stick to my meds.

Title: Re: Endoscopic sinonasal surgery (part1)
Post by Lobster on Feb 19^th, 2007, 12:03pm

A few of us have noted a connection between our sinuses and our CH. Do a search on the 'Neti Pot' threads, for example.

For myself, a nasty sinus infection will trigger a cycle.

I had a thread years ago noting that when I did Imitrex Nasal I found blood on it after I pulled it out. I thought that my CH made my nose bleed. Turns out that I had a sinus infection when in cycle.

So would learning that sinus surgery took care of the issue for a select group surprise me? No... not at all.

Do I always have sinus problems when a cycle tries to start up? No.