Grover Patrick J, Pereira Erlick A C, Green Alexander L, Brittain John-Stuart, Owen Sarah L F, Schweder Patrick, Kringelbach Morten L, Davies Paul T G, Aziz Tipu Z
Nuffield Department of Surgery, University of Oxford and Oxford Functional Neurosurgery, Department of Neurological Surgery, The West Wing, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
J Clin Neurosci. 2009 Jul;16(7):861-6. doi: 10.1016/j.jocn.2008.10.012. Epub 2009 Apr 23.
Cluster headache is a severely debilitating disorder that can remain unrelieved by current pharmacotherapy. Alongside ablative neurosurgical procedures, neuromodulatory treatments of deep brain stimulation (DBS) and occipital nerve simulation have emerged in the last few years as effective treatments for medically refractory cluster headaches. Pioneers in the field have sought to publish guidelines for neurosurgical treatment; however, only small case series with limited long-term follow-up have been published. Controversy remains over which surgical treatments are best and in which circumstances to intervene. Here we review current data on neurosurgical interventions for chronic cluster headache focusing upon DBS and occipital nerve stimulation, and discuss the indications for and putative mechanisms of DBS including translational insights from functional neuroimaging, diffusion weighted tractography, magnetoencephalography and invasive neurophysiology.
丛集性头痛是一种严重使人衰弱的疾病，目前的药物治疗可能无法缓解。除了毁损性神经外科手术外，近年来，深部脑刺激（DBS）和枕神经刺激等神经调节治疗已成为难治性丛集性头痛的有效治疗方法。该领域的先驱者试图发布神经外科治疗指南；然而，仅发表了少量长期随访有限的病例系列。关于哪种手术治疗最佳以及在何种情况下进行干预仍存在争议。在此，我们回顾了目前关于慢性丛集性头痛神经外科干预的数据，重点关注DBS和枕神经刺激，并讨论DBS的适应症和假定机制，包括来自功能神经影像学、扩散加权纤维束成像、脑磁图和侵入性神经生理学的转化见解。
