fMRI Data Demonstrate Evidence of Change in Brain Connectivity following Migraine Surgery
Year: 2022
Type: article
Abstract: PURPOSE: While surgical management of migraine headaches is becoming more commonplace in the field of plastic surgery it is still met with some criticism in the greater medical community due to the subjective nature of patient-reported results.1 Many studies have demonstrated that cranial nerve decompression is both safe and effective for the relief of migraine symptoms.2,3 The purpose of this study is to use functional and structural MRI to demonstrate objective changes in the brains of subjects following successful migraine surgery. METHOD: Subjects were recruited from the senior author’s practice. They failed medical management of their migraine headaches and were been deemed appropriate candidates for migraine surgery. Subjects participated in one preoperative and one postoperative study visit. The postoperative visit took place a minimum of 6 months following surgery and/or when symptoms plateaued. Each study visit consisted of: 1) neurocognitive battery, 2) fMRI at rest, 3) fMRI while performing verbal fluency task, and 4) static T1 MRI. Statistical mapping was performed to analyze and compare pre- and postoperative fMRI data. Cortical reconstruction and volumetric segmentation were performed to measure cortical thickness and compare pre- and postoperative structural MRI data. Pre- and postoperative measurements were compared using a paired t-test. RESULTS: Preliminary data indicate that chronic migraine patients presenting for surgery score extremely high for depressive symptoms and demonstrate impairment in executive function in the form of poor focus/attention. Analysis of our completed postoperative study visits shows a dramatic improvement in depressive symptoms and a trend toward improved executive function, specifically in the form of verbal fluency tasks. Most interestingly we are seeing potential changes in functional connectivity on fMRI that may correlate with this improvement in verbal fluency. Both pre- and postoperative fMRI images show responses in regions typically activated during this task, but the postoperative images show greater involvement of the right inferior frontal gyrus, in addition to the standard regions. The inferior frontal regions form part of Broca’s area that is typically involved in language production and fluency tasks. This suggests a more co-hemisphere pattern on this task postoperatively, compared to a left-lateralized pattern before surgery. CONCLUSION: Our results further support migraine surgery as a safe and effective procedure. We also demonstrate improvement in depression scoring and attention following surgery. Most importantly we demonstrate objective change in postoperative fMRI data that accompanies the improvement in neurocognitive data. Migraine surgery affects objective, measurable change in subjects’ brains. REFERENCES: 1. McGeeney, B. E. Migraine Trigger Site Surgery is All Placebo. Headache. 2015; 55(10), 1461 – 1463. 2. Guyuron B, Kriegler JS, Davis J, Amini SB. Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg. 2005 Jan;115(1):19 3. Ascha M, Kurlander DE, Sattar A, Gatherwright J, Guyuron B. In-depth review of symptoms, triggers, and treatment of occipital migraine headaches (site IV). Plast Reconstr Surg. 2017 Jun;139(6):1333e1342e.
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W4378942560