The effect of preoperative migraine headache frequency on surgical outcomes.

BACKGROUND: The Global Burden of Disease ranks migraine headache among the most disabling of conditions, and in the United States, migraine headache is one of the top five causes of visits to the emergency room. As migraineurs turn to surgical treatment for relief, it is unknown how migraine frequency influences outcomes. METHODS: In total, 488 patients prospectively completed the migraine headache questionnaires preoperatively and at least 11 months postoperatively. Patients were grouped into three cohorts based on migraine frequency of one to 14 per month (episodic), 15 to 29 per month (chronic), or at least daily (daily). Statistics were performed with paired t tests, linear regression, and analysis of variance with Tukey's honestly significant difference test. RESULTS: All groups experienced a significant benefit from surgery in terms of frequency, duration, and severity of migraine headache, and Migraine Headache Index. Patients experienced significantly different final outcomes based on their frequency cohort with respect to duration (p = 0.02), frequency (p < 0.0001), and Migraine Headache Index (p < 0.0001). However, when the preoperative score is controlled for, the only significant difference between cohorts occurred in Migraine Headache Index among daily migraineurs compared with episodic (p = 0.0003) and chronic (p = 0.0008) migraineurs. No other significant findings persisted. CONCLUSIONS: All cohorts, regardless of their frequency of migraine headache, achieved significant improvement in frequency, duration, severity, and Migraine Headache Index. The groups also achieved statistically different final outcomes, but no group benefits more than the other when improvement is quantified, and patients can expect similar relative improvement.

Augmentation of intraorbital volume with fat injection.

BACKGROUND: Enophthalmos is a challenging surgical problem to correct. Standard techniques to adjust orbital volume require invasive maneuvers such as osteotomies. Fat injection may provide a simple and less-invasive way of augmenting orbital volume to correct enophthalmos. METHODS: The right eye orbital volume of 10 New Zealand White rabbits was augmented with fat. Autologous fat was diced and injected into the retrobulbar space. Computed tomographic scans were evaluated for changes in globe position and retrobulbar volume. Visually evoked potentials were conducted to test the integrity of the optic tract. Rabbits were killed at 12 weeks after surgery. Orbital exenterations were performed to allow for gross and histologic evaluation. RESULTS: Right globe position showed a mean increase in eye proptosis of 3.4 mm at postoperative day 1 and 0.9 mm at 11 weeks postoperatively in comparison with the left globe position. No significant change was noted in the left globe position. Retrobulbar volume demonstrated an initial mean increase of 31 percent and a final mean increase of 9.8 percent at 11 weeks in the right eye compared with the left eye. Visually evoked potentials revealed intact optic pathways in all animals. Gross anatomical evaluation showed deposition of fat grafts. Histologic analysis showed both revascularized and necrotic areas of fat. No retinal or optic nerve damage was identified. CONCLUSIONS: Fat injection can augment orbital volume in an animal model and preserve visual function. Further investigation is necessary to document the clinical safety and value of this technique in humans.