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Morphologic vascular anomalies detected during migraine surgery

  • Edoardo Raposio
    Correspondence
    Corresponding author at: Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics, University of Genova, L.go R. Benzi 10, 16132, Genova, Italy.
    Affiliations
    Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy

    Plastic and Reconstructive Surgery Division, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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  • Giorgio Raposio
    Affiliations
    Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy
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  • Denise Del Duchetto
    Affiliations
    Plastic Surgery Chair, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy
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  • Author Footnotes
    1 These authors contributed equally to the study.
    Erica Tagliatti
    Footnotes
    1 These authors contributed equally to the study.
    Affiliations
    Laboratory of Pharmacology and Brain Pathology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy

    Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
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  • Author Footnotes
    1 These authors contributed equally to the study.
    Katia Cortese
    Footnotes
    1 These authors contributed equally to the study.
    Affiliations
    Cellular Electron Microscopy Lab, Department of Experimental Medicine (DIMES), Human Anatomy, University of Genova, Genoa, Italy
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  • Author Footnotes
    1 These authors contributed equally to the study.
Published:August 21, 2022DOI:https://doi.org/10.1016/j.bjps.2022.08.036

      Abstract

      Although there is increasing evidence of migraine headaches having extracranial origins, the exact mechanisms underlying the pathogenesis of surgically treated migraines continue to be poorly investigated and described.
      We studied the microscopic and ultrastructural characteristics of superficial temporal artery (STA) and occipital (OA) artery in the auriculotemporal and great occipital trigger points of migraine patients to determine their possible role in migraine etiopathogenesis. Fifteen biopsies, 10 of STA and 5 from OAs, were collected intraoperatively during migraine surgery and immediately processed for optical and ultramicroscopic analysis.
      We detected the following anomalies in all the specimens: (a) endothelial damage with internal elastic lamina fragmentation and intimal thickening; (b) marked irregularity in the shape and metachromasia of the vascular smooth muscle cells (VSMCs), separation of cells by abundant extracellular matrix and vacuoles. The electron microscopy analysis confirmed that presumed VSMCs infiltrated the intima layer revealing a consistent shift of VSMCs from contractile to synthetically active phenotypes, endosome-like organelles, multilamellar structures, abundant extracellular vacuoles filled with fine granular material and membranes, and extracellular vesicles in the matrix space surrounding synthetically active cells.
      Our study revealed specific alterations in the vasculature at the neurovascular bundles of the temporal and occipital trigger sites. These findings are indicative of an active involvement of the arteries in the auriculotemporal and great occipital trigger sites in evoking migraine.

      Keywords

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