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前额神经:一种新发现的额颞神经血管束及其在额叶头痛,偏头痛手术和美容性寺庙填充物注射治疗中的意义

Accessory Nerves of the Forehead

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【 文献重点摘要 】
 

Background: Surgical decompression of peripheral cranial and spinal nerves at several anatomically studied trigger sites has demonstrated significant efficacy in bringing permanent relief to migraine sufferers. In their experience performing frontal nerve decompression on migraine patients, the authors noticed a previously undescribed accessory nerve and vessel in the frontotemporal area, and report its implication in migraine surgery and cosmetic filler injection.

 

Methods: A retrospective review of 113 patients who underwent frontal migraine decompression surgery with the senior author at the University of Texas Southwestern Medical Center from July of 2012 to May of 2016 was performed. For the included 76 patients, measurements of this nerve had been taken intraoperatively using high-definition endoscopic assistance, and topographic measurements were correlated with endoscopic location of the nerve.

 

Results: This frontotemporal nerve (FTN) was present in 55 percent, and the bilateral incidence was 57 percent of those. An accompanying vessel was also present in 81 percent of nerve complexes. Both nerve and vessel varied in size. A large vessel was present in 8 percent of all patients, and a medium vessel was present in 20 percent. Consistently, the nerve exited a foramen in the frontal bone on average 3.4 ± 0.47 cm superior to the lateral canthus.

 

Conclusions: The identification and proper avulsion neurectomy of this newly described sensory FTN may lead to better surgical response rate during migraine surgery. In addition, this nerve should be considered during nerve block and botulinum toxin injections in migraine treatment. The existence of the accompanying vessel could have significant implications in the safety of filler and fat injections to this area.

 

背景:在几个解剖学研究的触发点进行外周、颅神经和脊神经的外科减压术在给偏头痛患者带来永久性缓解方面显示出显著的效果。在对偏头痛患者行额神经减压术的经验中,作者注意到在额颞区有一以前未被描述的副神经和血管,并报告了它在偏头痛手术和美容填充剂注射中的意义。

 

方法:对2012年7月至2016年5月在德克萨斯大学西南医学中心与资深作者一起行额偏头痛减压术的113例患者进行回顾性分析。对于纳入的76名患者,术中使用高清晰度内窥镜辅助对该神经进行了测量,并且地形图测量与该神经的内窥镜位置相关。

 

结果:额颞神经出现率为55%,双侧出现率为57%。81%的神经复合体中也存在伴行血管。神经和血管大小不一。在所有患者中,8%的患者存在大血管,20%的患者存在中型血管。神经始终性地出于额骨孔,距外眼角平均3.4±0.47 cm。

 

结论:在偏头痛手术中,识别并恰当切除这种新的感觉神经FTN可能会导致更好的手术反应率。此外,在偏头痛的神经阻滞和肉毒杆菌毒素注射治疗中,应该考虑这种神经。伴行血管的存在可能会对该区域的填充物和脂肪注射的安全性产生重大影响。

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