Evidence-Based Patient Selection in Headache Surgery: Impact of Preoperative Radiofrequency Ablation on Surgical Outcomes

• Published in: Plastic and reconstructive surgery (1963) Vol. 151; no. 5; p. 1071
• Main Authors: Casari, Maria E, Chartier, Christian, Gfrerer, Lisa, Austen, Jr, William G
• Format: Journal Article
• Language: English
• Published: United States 01.05.2023
• Subjects: Headache - etiology; Headache - surgery; Humans; Migraine Disorders - surgery; Patient Selection; Radiofrequency Ablation - adverse effects; Treatment Outcome
• ISSN: 1529-4242
• DOI: 10.1097/PRS.0000000000010044

Radiofrequency ablation (RFA) of the greater occipital nerve (GON) is a minimally invasive treatment option commonly used in patients with occipital neuralgia. Patients who undergo occipital surgery for headaches after failed RFA treatment present a unique opportunity to evaluate RFA-treated occipital nerves and determine the impact on headache surgery outcomes. Of 115 patients who underwent headache surgery at the occipital site, 29 had a history of RFA treatment. Migraine Headache Index, Pain Self- Efficacy Questionnaire, and Pain Health Questionnaire-2 outcome scores were recorded preoperatively and at follow-up visits. Intraoperative macroscopic nerve damage and surgical outcomes were compared between RFA-treated and non-RFA-treated patients. RFA-treated patients had a higher rate of macroscopic nerve damage (45%) than non-RFA-treated patients (24%) ( P = 0.03), and they were significantly more likely to require a second operation at the site of primary decompression (27.6% versus 5.8%; P = 0.001) and GON transection (13.8% versus 3.5%; P = 0.04). Outcome scores at the last follow-up visit showed no statistically significant difference between RFA-treated and non-RFA-treated patients ( P = 0.96). RFA-treated patients can ultimately achieve outcomes that are not significantly different from non-RFA-treated patients in occipital headache surgery. However, a higher number of secondary operations at the site of primary decompression and nerve transection are required to treat refractory symptoms. RFA-treated patients should be counseled about an increased risk of same-site surgery and possible GON transection to achieve acceptable outcomes. Therapeutic, III.