MDNews - Cleveland-Akron-Canton

Surgical deactivation of trigger sites — a procedure also known as nerve decompres- sion surgery or migraine surgery, which Dr. Guyuron pioneered in 1999 — has been shown in 24 studies published by Dr. Guyuron and his colleagues to improve or eliminate MH by 80 to 90 percent. Independent studies by other physician researchers across the U.S. have duplicated these results. "After 15 years of research involv- ing approximately 1,000 patients and 2,600 procedures, we have a science and evidence behind the surgery to prove to ourselves first and then prove to the medical community that migraine surgery works," Dr. Guyuron says. The Original Study A n incidenta l discover y sparked Dr. Guyuron's interest in MH research. In late 1999, one of his patients reported complete relief from her migraine headaches six months after forehead rejuvenation surgery, which involved removal of the corrugator supercilii muscle. Dr. Guyuron thought it was a coincidence until several more patients reported similar experiences. I nt r ig ue d b y t he p o s sibi l it ie s, Dr. Guyuron conducted a retrospective study of 314 patients who underwent the same surgery from 1989 to 1999. He found that of 39 patients with MH who had undergone a forehead aesthetic procedure, 15 (38.5 percent) reported complete elimination of their headaches, and 16 patients (41 percent) observed "significant improvement" — defined as a 50 percent or more reduction in severity, frequency and duration of MH. "For every patient, the migraine diagno- sis was made by a neurologist based on the International Headache Society criteria or by a physician," says Dr. Guyuron. "To ensure a valid outcome, only elimina- tion or significant improvement of MH was considered. Slight or even moderate improvement in MH was not considered." Suspecting that the corrugator supercilii muscle in the forehead was irritating nerves and causing nerve inflammation that triggers frontal MH, Dr. Guyuron designed a pilot study in which surgery was performed solely for MH treatment. Using Botulinum toxin A (BT-A) to identify patients who would likely have a successful outcome following surgery, Dr. Guyuron operated on 22 patients. Within seven to 16 months, 21 of the 22 patients reported significant benefits from the surgery. Anatomical Research Highly encouraged, Dr. Guyuron designed subsequent studies with two neurologists to identify additional MH trigger sites and to develop surgical techniques to deactivate them. "We went to the anatomy lab to do stud- ies and found, in addition to the trigger site in the forehead, three more trigger sites — in the temple area, the occipital area and inside the nose," Dr. Guyuron says. "For the latter trigger site, the pain usually starts behind the eyes and may spread to different areas." For patients whose MH centered in the temple area, Dr. Guyuron found he could remove a small branch of the trigeminal nerve to offer relief. For patients who suf- fered from occipital MH, removing a small piece of muscle encasing the nerve was effective. For headaches located behind the eyes and triggered by weather changes, Dr. Guyuron developed a procedure involving the septum and the turbinates and surrounding structures. A comprehensive study on all four trigger sites, was completed in 2002. Follow-up data gathered at least one year after surgery showed that of the 89 patients who underwent surgical deactivation of trigger sites, 82 (92 percent) demonstrated either complete elimination (35 percent) or significant improvement (57 percent) of MH. Five-year follow-up data was the same. The complications and ill effects were carefully recorded and found to be rare, temporary and often correctable. Placebo/Sham Surgery Studies In another unprecedented study, Dr. Guyuron performed surgery on 76 patients who had MH trigger sites in just one area. Some patients were randomly selected for placebo surgery. A B O U T D R . G U Y U RO N BORN AND R AISED in Iran, Dr. Guyuron graduated from Tehran University with a medical doctorate. In 1973, he came to the United States to seek specialized training — first in general surgery at Boston University, then in plastic surgery at Cleveland Clinic. He completed a fellowship in Craniofacial Surgery at Toronto University before return- ing to Cleveland Clinic to direct the Section of Craniofacial Surgery. More recently, from 2007–2015, he chaired the Department of Plastic and Reconstructive Surgery at University Hospitals Case Medical Center in Cleveland, Ohio. "I started a residency program in neurosurgery in Boston. At that time, the state-of-the-art for neurosurgery wasn't anywhere near as good as it is now, and most of the patients I attended to were paralyzed or had a very poor prognosis. I didn't think I could deal with that for the rest of my career," Dr. Guyuron explains. "So I chose a specialty in which I thought I could produce more positive results — the craniofacial branch of plastic surgery." For the next two decades, Dr. Guyuron honed his art. He reconstructed the heads and necks of trauma patients, studied the effect of irradiation on facial growth, simpli- fied the harvesting of ear cartilage graft, pioneered a procedure to combine maxillary and mandibular osteotomies, and developed new techniques for aesthetic facial surgery. And he taught other surgeons to do the same — through 241 peer-reviewed journal articles (24 of which are focused on migraine headaches), 61 abstracts, 5 textbooks and 56 textbook chapters, 35 live surgical presentations, and 1,217 invited lectures and presentations at local, national and international meetings. He has also served as Director of the American Board of Plastic Surgery and President of six professional medical associations, including the American Association of Plastic Surgery, the most prestigious in this specialty area. 2 0 1 5 J U LY/AU G U S T ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 7

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