gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Chronic SUNCT syndrome treated with hypothalamic stimulation using indirect anatomical landmarks for planning of the target point: Case report and technical note

Meeting Abstract

  • D. Falk - Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel
  • T. Bartsch - Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel
  • N. Warneke - Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel
  • J. Volkmann - Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel
  • H.M. Mehdorn - Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 018

DOI: 10.3205/11dgnc239, URN: urn:nbn:de:0183-11dgnc2392

Veröffentlicht: 28. April 2011

© 2011 Falk et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: SUNCT-syndrome is a rare pain syndrome. It presents with short-term unilateral neuralgiform headache attacks with conjuntival injection, tearing, sweating and rhinorrhea. Due to failure of non-invasive medical therapies, single cases of deep brain stimulation are described with conflicting reported benefits.

Methods: We report on one patient with SUNCT-syndrome, who presented with the typical signs. Due to failure of non-invasive therapies and microvascular decompression of the trigeminal nerve, we decided to stimulate the ipsilateral posterior ventral hypothalamus. Because the patient had a cardiac pacemaker, no complete MRI could be performed and the planning had to be completed solely via a T1-weighted sequence. Due to brain atrophy, the standard coordinates could not be used. Therefore we used indirect landmarks in the atlas, like the corpora mamillaria, for targeting.

Results: For this procedure, the following coordinates in relation to the mid-AC-PC-point were used: x=5 mm, y=0 mm, z=5 mm. The following surgery was performed under local anesthesia with microrecording and macro stimulation. Under permanent stimulation, improvement with complete reduction of pain attacks was achieved from the first day of stimulation and in the half year follow-up.

Conclusions: We conclude that deep brain stimulation of the posterior ventral hypothalamus could be an effective method for the treatment of the SUNCT-syndrome. However, we have shown that planning with the atlas and indirect landmarks is a possible way to find atypical positions of the target point.