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CT Analysis of the Supraorbital Region in Frontal Migraine Headache Patients

Navid Pourtaheri MD PhD, Donald Harvey MD, James Gatherwright MD, Bahman Guyuron MD FACS
University Hospitals Case Medical Center, Cleveland, OH
2014-03-15

Presenter: Navid Pourtaheri MD PhD

Affidavit:
The entirety of this work is original and was completed by the authoring resident

Director Name: Hooman Soltanian, MD

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial

Background: CT of the face and sinuses plays an important role in pre-operative planning for rhinogenic migraine surgery. Many of these patients also undergo frontal migraine surgery. This study was conducted to investigate the ability to detect the presence of supraorbital notches and/or foramina (SON/SOF) on paranasal CT primarily obtained for planning rhinogenic migraine surgery, and to assess the correlation of these anatomical findings with the Migraine Headache Index (MHI) in this patient population.

Methods: 3D reconstructions were generated from paranasal CT data obtained for planning rhinogenic migraine surgery in 56 patients who received rhinogenic and frontal migraine surgery. 3D images were analyzed for the presence of SON/SOF, and the diameter and distance from midline of each SON/SOF were measured and verified with the 2D images. Findings were also compared to the patients' pre-operative MHI.

Results: On CT, patients most commonly had bilateral SON (n=33); mixed SON and SOF (n=14) and bilateral SOF (n=9) were less common. The average SON and SOF diameters were 2.15mm and 1.22mm, respectively. The mean distance from the SON/SOF center to the nasal midline was 2.46cm (right) and 2.36cm (left). When CT findings were compared with preoperative MHI, patients with bilateral SOF reported higher scores than patients with bilateral SON (p=0.01).

Conclusion: Paranasal sinus CT can be used to detect the size, shape, and location of SON/SOF in frontal migraine patients, which may aid surgical planning. Clinically, there is also an association between the presence of bilateral SOF and higher MHI scores.

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