Posttraumatic headache: surgical management of supraorbital neuralgia.
BACKGROUND
Supraorbital neuralgia is a distinct clinical entity that presents with episodic, often unilateral, long-lasting attacks of moderate to severe frontal pain. This may ensue following a traumatic or surgical insult to the supraorbital or supratrochlear nerve. Surgical management of these patients is only sporadically discussed in the available literature.


METHODS
The authors report a series of six consecutive patients undergoing surgical excision of the supraorbital and supratrochlear nerves on the affected side for refractory posttraumatic or postoperative supraorbital neuralgia. End-to-end nerve coaptation by means of a neural tube conduit was used to prevent future neuroma formation. Success was defined as a 50 percent or greater reduction of preoperative pain level.


RESULTS
Five of six patients demonstrated at least a 50 percent reduction in pain. Three patients experienced complete pain cessation postoperatively. There was one treatment failure. Pain was measured using a visual analogue pain scale. Preoperative average pain was 9.16 +/- 1.3 and postoperative average pain was 1.5 +/- 1.9, an improvement of 7.7 points or 84 percent (p = 0.03). Mean age of the patients was 42 years. Mean follow-up was 14 months. No surgical complications occurred.


CONCLUSIONS
Excision of the supraorbital and supratrochlear nerves with end-to-end coaptation of the proximal nerve stumps by means of a neural tube appears to be an effective treatment in selected patients with chronic, posttraumatic supraorbital neuralgia.
Ducic
Ivica
I
Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital.
Larson
Ethan E
EE
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D051298:Post-Traumatic Headache / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome