6 de maio de 2024

Entenda os 7 tipos de cirurgias de enxaqueca e saiba como o procedimento é eficaz contra o problema

11 de novembro de 2020
enxaqueca

Desenvolvida em 2000 e respaldada por vários estudos científicos, cirurgia é pouco invasiva e tem o objetivo de descomprimir e liberar os ramos dos nervos trigêmeo e occipital, envolvidos nos pontos de dor

      A enxaqueca afeta 15% da população brasileira, segundo estatísticas, e já existe uma forma mais eficaz de lidar com o problema: é a Cirurgia de Enxaqueca.

     Hoje realizada por diversos grupos de cirurgiões plásticos ao redor do mundo e em mais de uma dezena das principais universidades americanas, como Harvard, o procedimento tem resultados muito positivos e semelhantes.
“As publicações dos diferentes grupos comprovam a eficácia e a reprodutibilidade do tratamento”, afirma o cirurgião plástico Dr. Paolo Rubez, membro titular da Sociedade Brasileira de Cirurgia Plástica e especialista em Cirurgia de Enxaqueca pela Case Western University.

   Mas afinal, por que investir em uma cirurgia para enxaqueca?

    De acordo com o Dr. Paolo Rubez, a enxaqueca tem sido associada à compressão e irritação dos principais nervos sensitivos do rosto e da cabeça.
“Em pessoas com predisposição genética para a Enxaqueca os nervos podem sofrer compressões ao longo de seus trajetos e desencadear a cascata de sintomas da doença. O alívio cirúrgico da compressão nos nervos pode reduzir a frequência, a intensidade e a duração das dores de cabeça ou até mesmo eliminá-las”, destaca.
Da mesma forma, a cirurgia é uma opção muito vantajosa para pacientes que sofrem com efeitos colaterais das medicações para dor ou que tenham intolerância a essas medicações.
Todos os tipos de cirurgia de enxaqueca são pouco invasivos, de forma que a cirurgia tem o objetivo de descomprimir e liberar os ramos dos nervos trigêmeo e occipital envolvidos nos pontos de dor.
“Os ramos periféricos destes nervos, responsáveis pela sensibilidade da face, pescoço e couro cabeludo, podem sofrer compressões das estruturas ao seu redor, como músculos, vasos, ossos e fáscias. Isto gera a liberação de substâncias (neurotoxinas) que desencadeiam uma cascata de eventos responsável pela inflamação dos nervos e membranas ao redor do cérebro, que irão causar os sintomas de dor intensa, náuseas, vômitos, sensibilidade à luz a ao som”, diz o Dr. Paolo Rubez.

Quem pode fazer a cirurgia de enxaqueca?

  •  paciente que tenha diagnóstico de Migrânea (Enxaqueca) feito por um neurologista,
  • que sofra com duas ou mais crises severas de dor por mês que não consigam ser controladas por medicações;
  • pacientes que tenham muitos efeitos colaterais com as medicações;
  • pacientes que desejam realizar o procedimento devido ao grande comprometimento que as dores causam em sua vida pessoal e profissional.

    Segundo o especialista, são sete os tipos de cirurgia, pois para cada um dos tipos de dor existe um acesso diferente para tratar os ramos dos nervos, sendo todos nas áreas superficiais da face ou couro cabeludo, ou ainda na cavidade nasal.
O cirurgião explica que cada cirurgia foi desenvolvida para gerar a menor alteração possível na fisiologia local.
“Em todos estes tipos o princípio é o mesmo: descomprimir e liberar os ramos do nervo trigêmeo ou occipital, que são irritados pelas estruturas adjacentes ao longo de seu trajeto”.

Conheça abaixo cada um deles:

Frontal

É um dos tipos mais comum e é realizado para os pacientes que têm o início das dores na região dos supercílios, segundo o médico.
“Esta cirurgia é feita a partir de incisões nas pálpebras superiores, como nas blefaroplastias, ou incisões no couro cabeludo. As cicatrizes, portanto, ficam imperceptíveis. Nesta cirurgia, é realizada a remoção dos músculos corrugadores do supercílio, depressores do supercílio e próceros, além de artérias locais, que causam irritação aos ramos supraorbital e supratroclear do nervo trigêmeo”, afirma o médico.
Além de tratar a enxaqueca, o paciente desse tipo de cirurgia, como consequência do procedimento, diminui a formação de rugas nestas áreas, contribuindo para um efeito rejuvenescedor da face.

Temporal

“Neste procedimento as incisões são realizadas no couro cabeludo, e tem como objetivo descomprimir ou ressecar parte do nervo zigomático-temporal, o qual é rotineiramente lesado em cirurgias estéticas para a face”, afirma o médico.
A perda parcial de sensibilidade na região temporal pode ser temporária ou definitiva e nesta cirurgia também ocorre efeito rejuvenescedor da face, uma vez que os tecidos da região são levemente tracionados para lateral, causando elevação discreta da sobrancelha.

Aurículo-temporal 

  Pacientes que apresentem dores na lateral da cabeça, ou seja, nas têmporas, podem se submeter a cirurgia para o nervo aurículo-temporal.
“Assim como as demais, fará a descompressão dos nervos localizados na região temporal — bem próximo à orelha—, minimizando os sintomas da enxaqueca. Em alguns casos, a condição pode ser eliminada por completo. Esta cirurgia pode ser feita sob anestesia local, com duração de cerca de 15 minutos”, afirma o médico.

Numular    

 A cirurgia de enxaqueca numular trata-se de um procedimento realizado sob anestesia local, com duração em torno de 15 minutos.

  “As dores são na região do couro cabeludo, mais comumente nas laterais da cabeça. O paciente em geral consegue identificar pontualmente o local de maior dor, que é confirmado com a utilização de um doppler. Através de pequena incisão é realizada a neurotomia de pequenos ramos nervosos, sendo que a cicatriz fica disfarçada pelo cabelo”, explica o cirurgião plástico.

Rinogênico

   Trata-se de cirurgia realizada toda por dentro do nariz, e destinada para os pacientes que apresentam dores que se iniciam atrás dos olhos, por exemplo, causadas por variações do clima.
“Os contatos entre o septo desviado e os cornetos (ou carne esponjosa) ativam a cascata de dores neste caso. O intuito da cirurgia, portanto, é corrigir eventuais desvios ou esporões do septo, hipertrofias de cornetos ou conchas bulhosas. Esta cirurgia vai promover um pós-operatório com melhora da respiração”, conta o especialista.

Occipital

   Este tipo é correspondente às dores atrás da cabeça ou na nuca, que podem ser causadas pela irritação de diversos nervos, sendo o principal o nervo occipital maior.
“A compressão do nervo pode ser feita por músculos ou vasos. Realiza-se, então, a remoção de parte do músculo semiespinal e descompressão do nervo em todo seu trajeto”, afirma.

Occipital Menor
   O nervo occipital menor, quando apresenta compressão, faz com que o paciente tenha dores na região lateral da nuca, semelhantes a uma dor muscular.
“Para melhorar a condição clínica, a cirurgia realiza a neurotomia (secção) do nervo. A incisão é pequena e no couro cabeludo do paciente, não resultando em cicatriz visível, e com melhora significativa do quadro de enxaqueca na grande maioria dos casos”, enfatiza o especialista.

    O Dr. Paolo Rubez enfatiza que as cirurgias são realizadas em ambiente hospitalar e sob anestesia geral e em alguns casos sob anestesia local.
“A duração da cirurgia, para cada nervo, é de cerca de uma a duas horas, e o paciente tem alta no mesmo dia, ou no dia seguinte, para casa”, explica.

Como surgiu a cirurgia para enxaqueca

   A Cirurgia para Enxaqueca foi criada e desenvolvida, a partir de 2000, pelo cirurgião plástico Dr. Bahman Guyuron, em Cleveland nos EUA. Desde então, diversas equipes ao redor de todo o mundo vêm realizando este tipo de cirurgia com sucesso. Único médico a realizar a cirurgia em São Paulo, Dr. Paolo Rubez aprendeu detalhes das técnicas cirúrgicas desse procedimento com o Dr. Bahman Guyuron, por meio de sete estágios entre os anos de 2014 e 2019.

            Segundo o Dr. Paolo Rubez, o procedimento foi criado a partir de cirurgias estéticas para a região frontal ou superior da face, de forma que o Dr. Guyuron notou que seus pacientes melhoravam das dores de enxaqueca, quando sofriam com o problema.
Em 2005, o Dr. Guyuron e sua equipe publicaram um estudo prospectivo com randomização entre um grupo tratado e um controle sem cirurgia, envolvendo no total 125 pacientes. Do grupo tratado 92% dos pacientes obtiveram sucesso com a cirurgia, sendo que 35% apresentaram eliminação completa dos quadros de Enxaqueca.

   “Nos trabalhos científicos sobre a Cirurgia de Enxaqueca, o sucesso do procedimento é definido como uma melhora de no mínimo 50% na intensidade, duração e frequência das crises. Este mesmo grupo de pacientes foi acompanhado por cinco anos e, em nova publicação de 2011, comprovou-se a manutenção da melhora dos pacientes operados”, finaliza.

PAOLO RUBEZ: Cirurgião plástico, membro titular da Sociedade Brasileira de Cirurgia Plástica, da Sociedade Americana de Cirurgia Plástica (ASPS) e da International Society of Aesthetic Plastic Surgery (ISAPS), Dr. Paolo Rubez é Mestre em Cirurgia Plástica pela Escola Paulista de Medicina da UNIFESP.

   O médico é especialista em Cirurgia de Enxaqueca pela Case Western University, com o Dr Bahman Guyuron (em Cleveland – EUA) e em Rinoplastia Estética e Reparadora, pela mesma Universidade e pela Escola Paulista de Medicina/UNIFESP. http://drpaolorubez.com.br/

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