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Supraorbital Rim Syndrome (SORS): Definition, Surgical Treatment, and Outcomes for Frontal Headache
Robert R Hagan, MD1; Jeffrey Janis, MD2; Michael A Fallucco, MD3
1Neuropax Clinic, St. Louis, MO, 2Ohio State University, Columbus, OH 3Florida Plastic Surgery Group, Jacksonville, FL
Background: Supraorbital Rim Syndrome (SORS) is a novel term attributed to a composite of anatomically defined peripheral nerve entrapment sites of the supraorbital rim region. The SORS term establishes a more consistent nomenclature to describe the constellation of frontal peripheral nerve entrapment sites causing frontal headache pain. In this article, we describe the anatomical features of SORS as well as evidence to support its successful treatment using the trans-palpebral approach that allows direct vision of these sites and the intraconal space.
Methods: A retrospective review of 276 patients who underwent nerve decompression or neurectomy procedures for frontal or occipital headache was performed. Of these, 96 patientsŐ treatment involved frontal surgery, and 45 of these patients were pure SORS patients that underwent this specific frontal trigger site deactivation surgery only. All procedures involved direct surgical approach through the upper eyelid to address the nerves of the supraorbital rim at both the bony rim and myofascial unit sites.
Results: Pre- and post-operative data from the migraine disability assessment questionnaire (MIDAS) was analyzed with paired t-test. Following surgical intervention, MIDAS scores decreased significantly at 12 months post-operatively (p<.0001).
Conclusions: SORS describes the totality of compression sites both at the bony orbital rim as well as the corrugator myofascial unit for the supraorbital rim nerves. Proper diagnosis, full anatomical site knowledge and complete decompression allows for consistent treatment. Further, the direct, transpalpebral surgical approach provides significant benefit to allow complete decompression.
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