Superselective Craniofacial Nerve Decompression in a Pediatric Patient: A Case Report.

Area of Science:

• Neurosurgery
• Pain Management
• Pediatric Neurology

Background:

• Peripheral nerve release is a treatment for migraines from craniofacial compression neuropathies.
• Occipital nerve decompression is established, but supraorbital and zygomaticotemporal nerve management is less defined.
• Conventional approaches involve extensive incisions, potentially increasing complications and impacting aesthetics.

Purpose of the Study:

• To present a pediatric case of super-selective supraorbital and zygomaticotemporal nerve release.
• To demonstrate a staged surgical approach for frontotemporal compression neuropathies.
• To highlight a minimally invasive technique with concealed incisions and reduced risk of nerve injury.

Main Methods:

• A staged surgical approach was used in a 15-year-old girl with chronic occipital neuralgia.
• Super-selective supraorbital nerve release via 1 cm incisions along the brow's inferior border.
• Subsequent decompression of the zygomaticotemporal nerve using 1 cm pretrichial incisions.

Main Results:

• Immediate and sustained resolution of frontal migraines post-supraorbital nerve release.
• No sensorimotor dysfunction or significant scarring.
• Complete resolution of occipital and frontal symptoms, with marked improvement in temporal migraines one year postoperatively.

Conclusions:

• Clinically guided, staged surgical approach is effective for pediatric frontotemporal compression neuropathies.
• Super-selective nerve release offers targeted treatment with concealed incisions.
• The technique minimizes the risk of iatrogenic facial nerve injury and improves aesthetic outcomes.