1 Department of Neurosurgery, Oxford University Hospital Foundation Trust, Oxford, UK.
2 Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, UK.
Cephalalgia. 2019 Aug;39(9):1111-1120. doi: 10.1177/0333102419839992. Epub 2019 Mar 21.
We present long-term follow-up results and analysis of stimulation sites of a prospective cohort study of six patients with chronic cluster headaches undergoing deep brain stimulation of the ipsilateral posterior hypothalamic region.
The primary endpoint was the postoperative change in the composite headache severity score "headache load" after 12 months of chronic stimulation. Secondary endpoints were the changes in headache attack frequency, headache attack duration and headache intensity, quality of life measures at 12, 24, and 48 months following surgery. Stimulating contact positions were analysed and projected onto the steroetactic atlas of Schaltenbrand and Wahren.
There was a significant reduction of headache load of over 93% on average at 12 months postoperatively that persisted over the follow-up period of 48 months ( = 0.0041) and that was accompanied by a significant increase of reported quality of life measures ( = 0.03). Anatomical analysis revealed that individual stimulating electrodes were located in the red nucleus, posterior hypothalamic region, mesencephalic pretectal area and centromedian nucleus of the thalamus.
Our findings confirming long-term effectiveness of deep brain stimulation for chronic cluster headaches suggest that the neuroanatomical substrate of deep brain stimulation-induced headache relief is probably not restricted to the posterior hypothalamic area but encompasses a more widespread area.
我们呈现了一项前瞻性队列研究的长期随访结果和分析，该研究纳入了 6 例慢性丛集性头痛患者，对其同侧下丘脑后部进行了深部脑刺激。
主要终点是慢性刺激 12 个月后复合头痛严重程度评分“头痛负荷”的术后变化。次要终点是头痛发作频率、头痛发作持续时间和头痛强度的变化，以及术后 12、24 和 48 个月时生活质量测量的变化。分析了刺激接触位置，并投射到 Schaltenbrand 和 Wahren 的立体定向图谱上。
术后 12 个月平均头痛负荷显著降低超过 93%，在 48 个月的随访期间持续存在（ = 0.0041），并伴随着报告的生活质量测量显著增加（ = 0.03）。解剖分析显示，个别刺激电极位于红核、下丘脑后部、中脑顶盖前区和丘脑中央中核。
我们的研究结果证实了深部脑刺激治疗慢性丛集性头痛的长期有效性，表明深部脑刺激诱导的头痛缓解的神经解剖学基础可能不仅限于下丘脑后部，而是涵盖了更广泛的区域。
