["Functional" neurovascular decompressive surgery of cranial rhino- base in headaches with rhinogenic triggering]

Today one must include neurovascular decompression of the rhino-cranial base among the various forms of functional nasal surgery and the classical chapter on "Cephalea of rhinological origin" must be reviewed. In fact, all those forms of "apparently primary" headaches (i.e. migraine with and without aura, cluster headache, chronic paroxysmal migraine, tension headache) which have a central-peripheral etiopathogenesis due to a documented (CT) reduction in the volume of the "subcribriform ethmoid-sphenoidal chambers" affecting the hemoangiokinetics of endo-exocranial anastomotic circulation in this area. Rhino-cranial base neurovascular decompression surgery is described employing a "septo-ethmoid-sphenectomy". This surgery can either be conservative or radical, reaching the third degree monolateral with selective trigeminal-vegetative deafferentiation; this makes it possible to save the sense of smell, resolve the controlateral pain by decompressing the blood flow and even eliminate controlateral stasis. In addition, in a high percentage of cases, symptoms of neurological deficit or central irritation (i.e. visual aura, senso-motory palsy, epilepsy) disappear or are markedly improved after surgical elimination of the "peripheral rhinogenetic trigger". In a sample of 1000 of the 2124 patients who had undergone surgery from 1964 through the end of 1994, yearly follow-ups indicated that surgery cured or substantially improved 88%. On the other hand in 204 patients with similar forms of cephalea in advanced prophylaxis, 98% showed healing with "rapid disjunction of the palate" through "ortognatorhinodoncy" aimed at decompressing the neurovascular structure of the subcribrose chamber.