gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Article

Send article

Deep brain stimulation of the posterior hypothalamic area for the treatment of chronic cluster headache

Tiefenhirnstimulation im Hypothalamus zur Behandlung von chronischem Cluster-Kopfschmerz

Meeting Abstract

Search Medline for

  • corresponding author D. Rasche - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
  • V.M. Tronnier - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSO.08.05

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc213.shtml

Published: May 8, 2006

© 2006 Rasche 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: Chronic cluster headache (CCH) is one of the frequent headache syndromes with unilateral, attack-like pain of severe intensity. Pharmacological therapy is usually the treatment of choice. PET and SPECT investigations revealed an increased activity in the hypothalamic area during pain attacks. Based on these results, some single centres worldwide perform deep brain stimulation (DBS) as an alternative and invasive treament option for patients with medically refractory CCH. A single case is reported, the theoretical neurophysiological mode of action, the effectiveness of DBS and a literature review are presented.

Methods: A 39-year-old woman suffered from chronic left-sided cluster headache for 14 months. Pharmacological treatment was ineffective or major side effects occurred. Using a stereotactic frame and target definition a DBS electrode (3387-28, Medtronic, Minneapolis, USA) was inserted in the posterior hypothalamic area and typical side effects such as dizziness, tachycardia, panic attacks or diplopia were evoked intraoperatively by supra-threshold stimulation.

Results: At the end of the operation, a cluster attack happened and was immediately stopped by activating subthreshold DBS. During a test trial with different stimulation parameters, the patient was pain-free with constant subthreshold DBS. If DBS was only activated at the beginning of cluster attacks, these were immediately stopped by the subthreshold stimulation. During the subthreshold DBS, no side-effects such as tachycardia or hydrouria were registered or mentioned by the patient. Because of this result, the stimulation device was internalized after seven days.

Conclusions: DBS of the ipsilateral posterior hypothalamus is able to suppress cluster attacks in patients with pharmacologically refractory CCH. The definite mode of action and data concerning the long-term follow-up are not known and need to be investigated.