Neuromodulation of the posterolateral hypothalamus for the treatment of chronic refractory cluster headache: Experience in five patients with a modified anatomical target

Seijo, F.; Ayala, Antonio Saiz; Lozano, Beatriz Rodríguez; Santamarta, Elena; Álvarez-Vega, Marco; Seijo, Elisa; León, Ramón Fernández de; Fernández-González, F; Pascual, Javier

doi:10.1177/0333102411430264

Cited by 65 publications

(58 citation statements)

References 36 publications

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“…Hormone levels like melatonin, cortisol, testosterone, prolactin and thyroid are not affected by long-term hDBS (30). No mood changes have been reported during long-term stimulation either, apart from one study in which euphoria/wellbeing was seen in three patients (38). One patient had an infection leading to removal of the stimulator and a subsequent full recovery (29).…”

Section: Tolerability and Adverse Events Following Long-term Hdbsmentioning

confidence: 97%

Neurostimulation in cluster headache: A review of current progress

2013

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Purpose of review: Neurostimulation has emerged as a viable treatment for intractable chronic cluster headache. Several therapeutic strategies are being investigated including stimulation of the hypothalamus, occipital nerves and sphenopalatine ganglion. The aim of this review is to provide an overview of the rationale, methods and progress for each of these. Latest findings: Results from a randomized, controlled trial investigating sphenopalatine ganglion stimulation have just been published. Reportedly the surgery is relatively simple and it is apparently the only therapy that provides relief acutely. Summary: The rationale behind these therapies is based on growing evidence from clinical, hormonal and neuroimaging studies. The overall results are encouraging, but unfortunately not all patients have benefited. All the mentioned therapies require weeks to months of stimulation for a prophylactic effect to occur, suggesting brain plasticity as a possible mechanism, and only stimulation of the sphenopalatine ganglion has demonstrated an acute, abortive effect. Predictors of effect for all modes of neurostimulation still need to be identified and in the future, the least invasive and most effective strategy must be preferred as first-line therapy for intractable chronic cluster headache.

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Section: Tolerability and Adverse Events Following Long-term Hdbsmentioning

confidence: 97%

Neurostimulation in cluster headache: A review of current progress

2013

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“…Recently, the American Headache Society Guideline classified DBS for CCH as B level negative evidence (possibly ineffective) [20]. On the other hand, we know this is a safe procedure and with a reasonable success rate as reported in several series [3,7,12,21,22]. Thus, in a study by Leone et al [21] (follow-up 8.7 years), long-lasting improvement occurred in 70% of the patients.…”

Section: Discussionmentioning

confidence: 96%

“…Our coordinates are a modification of the original ones from Leone et al [3] and were selected to avoid bleeding at the lateral wall of the third ventricle and to stimulate the origin of the parasympathetic system [12]. These coordinates are crossed, among other fascicles, by the MTF and the DLF [17].…”

Section: Discussionmentioning

confidence: 99%

“…The surgical technique has been already reported [12]. In summary, the stereotactic coordinates used were 4 mm lateral from the lateral wall of the third ventricle, 2 mm posterior to the midcommissural point, and 5 mm below the intercommissural line.…”

Section: Methodsmentioning

confidence: 99%

“…After surgery, patients in whom model 3389 (Medtronic ® ) was used underwent a control MRI with the stereotactic frame implanted following the SAR normative [14], and the remainder of the patients underwent a brain CT scan under the same conditions. In all of the cases the stereotactic coordinates of the deepest contact with respect to the intercommissural line were measured, and then, using an in-house trigonometric program, the coordinates of the active contact were de- termined with respect to the midcomisural point [12]. Finally, these coordinates were projected over several atlases to determine the anatomical structures involved in the stimulation [15][16][17], assuming that the volume of tissue activation had a radius of 3 mm with monopolar stimulation [12] With the aim to study the structural connectivity of our target, we did studies of diffusion tensor imaging (DTI) fiber tracking (FT), first in a patient with CCH who had been implanted with DBS and later in 11 healthy volunteers, looking at the same coordinates of the target.…”

Section: Methodsmentioning

confidence: 99%

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Long-Term Results of Deep Brain Stimulation of the Mamillotegmental Fasciculus in Chronic Cluster Headache

Seijo-Fernández¹,

Sáiz

Santamarta

et al. 2018

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) and the proper target for chronic cluster headache (CCH) are still subjects of controversy. Objectives: We present our long-term results of analysis of the target and its structural connectivity. Methods: Fifteen patients with drug-resistant CCH underwent DBS in coordinates 4 mm lateral to the III ventricular wall and 2 mm behind and 5 mm below the intercommissural point. The clinical parameters recorded were the number of weekly attacks, pain intensity, and duration of the headache. Structural connectivity was studied using 3-T MR diffusion tensor imaging (DTI). Results: All of our patients improved from a mean of 39 attacks/week to 2; pain intensity decreased from 9 to 3 out of 10, and the mean cephalalgia duration decreased from 53 to 8 min. The mean stereotactic coordinates of the effective contact location were 6.1 mm lateral to the midcommissural point and 1.2 mm behind and 4.0 mm below the intercommissural point. DTI analysis showed that this target was connected to tracts and nuclei of the posterior mesencephalic tegmentum, specifically the dorsal longitudinal and mamillotegmental fasciculi. Conclusions: Our data showed DBS to be a safe and useful procedure for the treatment of drug-resistant CCH; the rate of improvement was higher than those found in other series. Although these are promising results, larger series targeting those fasciculi with a longer follow-up are needed.

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