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The exact target for chronic cluster headache (CCH) and deep brain stimulation (DBS) are still matters of discussion.
Cluster headache is one of the trigeminal autonomic cephalalgias distinguished by nearly daily acute unilateral periorbital pain correlated with autonomic indications persisting 15–180 minutes. About 10 - 20% of CCH patients do not react to any medicine but deep brain stimulation (DBS). Despite the fact, neither the structures referred during CH nor which is the best target for CH is well recognized. In the study, issues related to DBS-CCH were explained.
The exact target for chronic cluster headache (CCH) and deep brain stimulation (DBS) are still matters of discussion. The study aimed long-term outcomes of examination of the target and its structural connectivity.
A total of fifteen patients with drug-resistant CCH went through DBS in coordinates 4 mm lateral to the III ventricular wall and 5 mm below and 2 mm behind the intercommissural point. Pain intensity, duration of a headache and number of weekly attacks considered as the clinical parameters. The 3-T MR diffusion tensor imaging (DTI) was used to examine structural connectivity.
Improvement in pain intensity from 9 to 3, reduced mean cephalalgia duration from 53 to 8 min and attacks/week from 39 to 2 were noticed among all patients. The mean stereotactic coordinates of the beneficial contact position were 6.1 mm lateral to the mid-commissural point and 4.0 mm below and 1.2 mm behind the intercommissural point. The target was associated with nuclei and tracts of the posterior mesencephalic tegmentum; specifically, the mamillotegmental and dorsal longitudinal fasciculi as per DTI reports.
Results
revealed DBS to be a beneficial and safe method to treat drug-resistant CCH. DBS
group exhibited a higher improvement rate than other groups. However these are
encouraging outcomes, larger series are required which targets those fasciculi
with a longer follow-up.
Stereotact Funct Neurosurg.
Long-Term Results of Deep Brain Stimulation of the Mamillotegmental Fasciculus in Chronic Cluster Headache.
Fernando J Seijo-Fernandez et al.
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