Mueller O M, Gaul C, Katsarava Z, Diener H C, Sure U, Gasser T
University Hospital Essen, Neurosurgery, Essen, Germany.
Cent Eur Neurosurg. 2011 May;72(2):84-9. doi: 10.1055/s-0030-1270476. Epub 2011 Mar 29.
Neuromodulation has been recognized as a valuable surgical treatment option for patients with refractory chronic cluster headache (CCH). Due to the small number of afflicted individuals, the knowledge about this specific therapy is limited. In this study, we present our experiences with bilateral occipital nerve stimulation (ONS) in patients with CCH focusing on patient selection, pre- and postoperative evaluation, surgical procedures, and outcome.
Since December 2008, 10 patients with CCH have been treated with ONS at our department. Patients were recruited and clinically followed by a neurologist and a neurosurgeon. Baseline data records on frequency, intensity, and duration of attacks as well as the use of medication were assessed with a 30-day diary. Standardized questionnaires were used pre- and postoperatively and during the follow-up on a regular basis. Surgical procedure and stimulation parameters were standardized for all patients. Lead implantation was followed by a test period of 30 days prior to implantation of the permanent generator. Mean follow-up time was 12 months (range 3-18).
All patients responded to the stimulation treatment. Frequency, duration, and severity of the cluster attacks were reduced in 90% of the patients. One patient had a significant reduction of his concomitant tension headache. 70 % of the patients needed less medication during the attacks. All patients reported an improvement in their quality of life. The SF-36 showed a tendency toward objective improvement in the field of psychological comfort. As a major adverse event, one generator had to be exchanged due to a local infection. Another patient had to be reoperated due to a scar tissue formation around the thoracic connector.
ONS is a valuable tool in the treatment of patients with refractory CCH. According to our data, the potential side effects and complication rates of the operation are small. With a meticulous selection of patients by an interdisciplinary team, CCH can bed improve in the majority of the patients. Yet, the optimal parameters for the stimulation regarding pulse width and frequency remain unclear. For this reason, we started a prospective single-center observational trial at our center in October 2009, including patients with ONS, to identify the best stimulation parameters.
神经调节已被公认为是难治性慢性丛集性头痛（CCH）患者的一种有价值的手术治疗选择。由于患病人数较少，关于这种特定疗法的知识有限。在本研究中，我们介绍了我们在CCH患者中进行双侧枕神经刺激（ONS）的经验，重点关注患者选择、术前和术后评估、手术过程及结果。
自2008年12月以来，我们科室对10例CCH患者进行了ONS治疗。患者由神经科医生和神经外科医生招募并进行临床随访。使用30天日记评估发作频率、强度和持续时间以及药物使用情况的基线数据记录。术前、术后及随访期间定期使用标准化问卷。所有患者的手术过程和刺激参数均标准化。在植入永久性发生器之前，先进行30天的试刺激期。平均随访时间为12个月（范围3 - 18个月）。
所有患者对刺激治疗均有反应。90%的患者丛集性发作的频率、持续时间和严重程度降低。1例患者伴随的紧张性头痛显著减轻。70%的患者在发作期间所需药物减少。所有患者均报告生活质量有所改善。SF - 36显示在心理舒适度方面有客观改善的趋势。作为主要不良事件，1个发生器因局部感染而不得不更换。另1例患者因胸部连接器周围形成瘢痕组织而需再次手术。
ONS是治疗难治性CCH患者的一种有价值的工具。根据我们的数据，该手术的潜在副作用和并发症发生率较低。通过跨学科团队精心挑选患者，大多数CCH患者的病情可得到改善。然而，关于脉冲宽度和频率的最佳刺激参数仍不清楚。因此，我们于2009年10月在我们中心启动了一项前瞻性单中心观察性试验，纳入接受ONS治疗的患者，以确定最佳刺激参数。
