Department of Neurosurgery, University of Wisconsin, Madison, WI 53792, USA.
Neurobiol Dis. 2010 Jun;38(3):361-8. doi: 10.1016/j.nbd.2009.05.020. Epub 2009 Jun 6.
Cluster headache is the most severe primary headache disorder known. Ten to 20% of cases are medically intractable. DBS of the posterior hypothalamic area has shown effectiveness for alleviation of cluster headache in many but not all of the 46 reported cases from European centers and the eight cases studied at the University of California, San Francisco. This surgical strategy was based on the finding of increased blood flow in the posterior hypothalamic area on H(2)(15)O PET scanning during spontaneous and nitroglycerin-induced cluster headache attacks. The target point used, 4-5 mm posterior to the mamillothalamic tract, is in the border zone between posterior hypothalamus, anterior periventricular gray matter, and inferior thalamus. Recently, occipital nerve stimulation has shown efficacy, calling in question the use of DBS as a first line surgical therapy. In this report, we review the indications, techniques, and outcomes of DBS for cluster headache.
丛集性头痛是已知的最严重的原发性头痛疾病之一。10%至 20%的病例无法用药物治疗。在欧洲中心报告的 46 例和旧金山加利福尼亚大学研究的 8 例病例中，后下丘脑区域的 DBS 对缓解丛集性头痛显示出有效性。这种手术策略基于在自发性和硝酸甘油诱导的丛集性头痛发作期间 H（2）（15）O PET 扫描中在后下丘脑区域发现的血流量增加。使用的靶点是乳头丘脑束后 4-5 毫米，位于后下丘脑、前脑室周围灰质和下丘脑的边界区域。最近，枕神经刺激显示出疗效，这使得 DBS 作为一线手术治疗的使用受到质疑。在本报告中，我们回顾了 DBS 治疗丛集性头痛的适应证、技术和结果。
