Stimulation of the Posterior Hypothalamus for Treatment of Chronic Intractable Cluster Headaches: First Reported Series

Franzini, Angelo; Ferroli, Paolo; Leone, Massimo; Broggi, Giovanni

doi:10.1093/neurosurgery/52.5.1095

Cited by 149 publications

(146 citation statements)

References 33 publications

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“…According to an interesting hypothesis, one of its main target, the posterior hypothalamus (pHyp), controls relationship between the neuropsychological circuits involved in pain behavior and the neurovegetative system. Franzini et al144 reported the first series of chronic pHyp stimulation, and since then, many authors have proposed it to treat severe pain syndromes. In a systematic review,145 the same authors reported that none of the four patients suffering from refractory neuropathic trigeminal pain benefited from the procedure, whereas all five patients affected with refractory TN due to MS and undergoing pHyp DBS experienced a significant decrease in pain attacks within the first trigeminal branch.…”

Section: Advances In Surgical Therapymentioning

confidence: 99%

Advances in diagnosis and treatment of trigeminal neuralgia

Montano¹,

Conforti²,

Bonaventura³

et al. 2015

TCRM

157

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Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN). Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression) and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures) have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that neurostimulation might represent an opportunity in TN refractory to other surgical treatments. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, and medical and surgical treatments, and discuss the significant advances in all these fields.

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Section: Advances In Surgical Therapymentioning

confidence: 99%

Advances in diagnosis and treatment of trigeminal neuralgia

Montano¹,

Conforti²,

Bonaventura³

et al. 2015

TCRM

157

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“…Our center detailed the first series in 2003, 16 and since then 16 patients with CCH have undergone DBS. Our inclusion criteria to date have been as follows: 1) diagnosis of CCH made by 2 independent neurologists specializing in headaches; 2) conservative prophylactic and abortive treatments already tried in adequate dosages both alone or in combination therapy (verapamil, lithium carbonate, methysergide, valproate, topiramate, gabapentin, melatonin, pizotifen, indomethacin, and steroids); and 3) normal neuroradiological examination, including brain CT, MR imaging studies of the craniocervical junction, and venous angiographic sequences.…”

Section: Case Studiesmentioning

confidence: 99%

“…Since the first reported series in 2003, 16 several authors have used chronic stimulation of the pHyp to treat rare and severe syndromes refractory to conservative therapies. More specifically, the series reported in the literature include 51 patients affected with CCH, 3,6,11,14,31,45,47 Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations…”

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confidence: 99%

Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations

Franzini¹,

Messina²,

Cordella³

et al. 2010

FOC

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110

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Object The aim of this study was to review the indications for and results of deep brain stimulation (DBS) of the posterior hypothalamus (pHyp) in the treatment of drug-refractory and severe painful syndromes of the face, disruptive and aggressive behavior associated with epilepsy, and below-average intelligence. The preoperative clinical picture, functional imaging studies, and overall clinical results in the literature are discussed. Methods All patients underwent stereotactic implantation of deep-brain electrodes within the pHyp. Data from several authors have been collected and reported for each clinical entity, as have clinical results, adverse events, and neurophysiological characteristics of the pHyp. Results The percentage of patients with chronic cluster headache who responded to DBS was 50% in the overall reported series. The response rate was 100% for short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing and for chronic paroxysmal hemicrania, although only 2 patients and 1 patient, respectively, have been described as having these conditions. None of the 4 patients suffering from refractory neuropathic trigeminal pain benefited from the procedure (0% response rate), whereas all 5 patients (100%) affected with refractory trigeminal neuralgia (TN) due to multiple sclerosis (MS) and undergoing pHyp DBS experienced a significant decrease in pain attacks within the first branch of cranial nerve V. Six (75%) of 8 patients presenting with aggressive behavior and mental retardation benefited from pHyp stimulation; 6 patients were part of the authors' series and 2 were reported in the literature. Conclusions In carefully selected patients, DBS of the pHyp can be considered an effective procedure for the treatment of refractory trigeminal autonomic cephalalgias, aggressive behavior, and MS-related TN in the first trigeminal branch. Only larger and prospective studies along with multidisciplinary approaches (including, by necessity, neuroimaging studies) can lead us to better patient selection that would reduce the rate of nonresponders.

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“…Franzini et al104 targeted the ipsilateral posterior hypothalamus for DBS and reported long-term pain relief in 5 patients with treatment-resistant cluster headache (CH). Subsequently, Schoenen et al105 studied ipsilateral ventroposterior hypothalamic DBS in 6 patients with intractable CH.…”

Section: Chronic Painmentioning

confidence: 99%

Deep Brain Stimulation: Technology at the Cutting Edge

Shah

Min

et al. 2010

J Clin Neurol

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Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy.

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Stimulation of the Posterior Hypothalamus for Treatment of Chronic Intractable Cluster Headaches: First Reported Series

Abstract: These preliminary results indicate a role for posterior hypothalamic stimulation, which was demonstrated to be safe and effective, in the treatment of drug-resistant chronic CHs. These data point to a central pathogenesis for chronic CHs.

Cited by 149 publications

References 33 publications

Advances in diagnosis and treatment of trigeminal neuralgia

Advances in diagnosis and treatment of trigeminal neuralgia

Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations

Deep Brain Stimulation: Technology at the Cutting Edge

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