Pathogenesis and surgical treatment of neurovascular primary headaches

The "neurovascular primary headaches" are syndromes also pertinent to otorhinolaringology when CT demonstrates a reduced volume of the "ethmoidosphenoidal subcribriform chamber" according to the endo-exocranial hemoangiokinetics of this area. It is emphasized that in drug-resistant headaches recovery or consistent definitive improvement can be achieved only after surgical correction of certain anatomical parameters (P. Bonaccorsi, V.J. Novak, S. Hoover). Bonaccorsi and Novak independently identified the actual pathophysiologic mechanism and trigger zone ("dysmorphism") for various types of neurovascular primary headaches. Patients (n = 446) with various types of headaches (migraine, cluster headache and so-called idiopathic or primary headaches) were operated upon between 1973 and 1994. Septal correction, resection of the middle and superior concha, ethmoidectomy, and sphenoidectomy on the corresponding headache side or occasionally on both sides were carried out. Most patients (356, 80%) were asymptomatic postoperatively, 45 (10%) had a sensation of pressure in the head on rare occasions but no further migraine, and 45 (10%) continued to experience headache that occurred only rarely and was mild and of short duration. The overall success rate was 90%. For cluster headache in 20 patients, we observed the following postoperative results: 19 cured (98%), 1 improved (2%).