gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Failure of deep brain stimulation of the posterior inferior hypothalamus in chronic Cluster headache: Report of two cases and review of the literature

Tiefe Hirnstimulation des posterioren inferioren Hypothalamus bei chronischem Cluster-Kopfschmerz: zwei Fallberichte und Review der Literatur

Meeting Abstract

  • corresponding author M.O. Pinsker - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
  • T. Bartsch - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
  • D. Falk - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
  • M. Wasner - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
  • J. Volkmann - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
  • J. Herzog - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
  • F. Steigerwald - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
  • G. Deuschl - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
  • H. M. Mehdorn - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.06.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc248.shtml

Published: April 11, 2007

© 2007 Pinsker et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Deep brain stimulation (DBS) has become a standard procedure for movement disorders such as Parkinson’s disease, essential tremor or dystonia. Recent publications have gained interest in the treatment of drug-resistant chronic cluster headache. Functional neuroimaging studies showed hypothalamus dysfunction as a possible responsible cause for chronic cluster headache attacks.

Methods: DBS of the posterior inferior hypothalamus was performed on two patients, one 55-year-old man with a severe case of cluster headache since 1996, and one 31-year-old woman with symptoms since 2002, which intensified in both cases in the last years despite high dose medical treatment. The electrodes were implanted stereotactically on the ipsilateral side in the following position in relation to Mid-AC-PC: 2 mm lateral, 3 mm posterior, 5 mm inferior.

Results: The postoperative course was uneventful, the MRI control documented regular position of the DBS electrodes. The current stimulation parameters were at 12 months postoperatively 0-; G+ 5,5 V; 60µs; 180 Hz (Case 1) and 0 -, G+ 3,0 V; 60µs; 185 Hz at 3 months postoperatively (Case 2). In summary, there was no pain control at all in both patients, the medical treatment remained unchanged. We did not observe any stimulation related side effects.

Conclusions: Deep brain stimulation of the posterior inferior hypothalamus is still an experimental procedure and should be restricted to highly experienced centres both in patient selection and stereotactic surgery. A multi-centre study is necessary to evaluate its effectiveness.