A Modified Procedure

During the last few years, multiple studies have demonstrated the efficacy of migraine and tension-type headache trigger site deactivation surgery, hence expanding the indications of endoscopic techniques and also increasing the therapeutic potentiality of plastic surgery.1–5 These procedures are performed based on headache onset location: 4 trigger points that may cause the compression of the trigeminal branches have been described.3 Intranasal abnormalities (headaches with an intranasal origin) are currently treated with septoplasty and turbinectomy; for patients whose headaches start in the temporal region, a segment of the zygomaticotemporal branch of the trigeminal nerve is resected; for the occipital trigger point, a portion of the semispinalis capitis muscle is removed and the underlying nerve is shielded using a subcutaneous flap to isolate it from surrounding muscles; finally, hyperactive muscles from the glabellar group are dissected in patients with forehead headaches. Currently, forehead headache triggers deactivation is performed through endoscopic surgical decompression of the peripheral branch of trigeminal nerve under general anesthesia. It relies on 3–5 1.5-cm-long access incisions, and it is performed by means of 2 distinct surgical instruments: an endoscope and a dissector. The aim of this study was to demonstrate the efficacy of surgical decompression by means of an innovative minimally invasive endoscopic selective myotomy technique, with the purpose of reducing the invasiveness of the currently adopted techniques