Kakusa Bina, Saluja Sabir, Dadey David Y A, Barbosa Daniel A N, Gattas Sandra, Miller Kai J, Cowan Robert P, Kouyoumdjian Zepure, Pouratian Nader, Halpern Casey H
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.
Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States.
Front Hum Neurosci. 2020 May 15;14:164. doi: 10.3389/fnhum.2020.00164. eCollection 2020.
Cluster headache (CH) is among the most common and debilitating autonomic cephalalgias. We characterize clinical outcomes of deep brain stimulation (DBS) to the posterior hypothalamic region through a novel analysis of the electrophysiological topography and tractography-based structural connectivity. The left posterior hypothalamus was targeted ipsilateral to the refractory CH symptoms. Intraoperatively, field potentials were captured in 1 mm depth increments. Whole-brain probabilistic tractography was conducted to assess the structural connectivity of the estimated volume of activated tissue (VAT) associated with therapeutic response. Stimulation of the posterior hypothalamic region led to the resolution of CH symptoms, and this benefit has persisted for 1.5-years post-surgically. Active contacts were within the posterior hypothalamus and dorsoposterior border of the ventral anterior thalamus (VAp). Delta- (3 Hz) and alpha-band (8 Hz) powers increased and peaked with proximity to the posterior hypothalamus. In the posterior hypothalamus, the delta-band phase was coupled to beta-band amplitude, the latter of which has been shown to increase during CH attacks. Finally, we identified that the VAT encompassing these regions had a high proportion of streamlines of pain processing regions, including the insula, anterior cingulate gyrus, inferior parietal lobe, precentral gyrus, and the brainstem. Our unique case study of posterior hypothalamic region DBS supports durable efficacy and provides a platform using electrophysiological topography and structural connectivity, to improve mechanistic understanding of CH and this promising therapy.
丛集性头痛（CH）是最常见且使人衰弱的自主神经性头痛之一。我们通过对基于脑电地形图和纤维束示踪的结构连接性进行新颖分析，来描述下丘脑后区深部脑刺激（DBS）的临床结果。左侧下丘脑后区是难治性CH症状同侧的靶点。术中，以1毫米深度增量采集场电位。进行全脑概率纤维束示踪，以评估与治疗反应相关的估计激活组织体积（VAT）的结构连接性。刺激下丘脑后区可使CH症状得到缓解，且这种益处术后持续了1.5年。有效触点位于下丘脑后部和腹前丘脑（VAp）的背后部边界。δ波（3赫兹）和α波频段（8赫兹）功率增加，并在下丘脑后部附近达到峰值。在下丘脑后部，δ波相位与β波振幅耦合，后者在CH发作期间已被证明会增加。最后，我们发现包含这些区域的VAT有很大比例的纤维束来自疼痛处理区域，包括岛叶、前扣带回、顶下小叶、中央前回和脑干。我们对下丘脑后区DBS进行的独特病例研究支持了持久疗效，并提供了一个利用脑电地形图和结构连接性的平台，以增进对CH及这种有前景治疗方法的机制理解。
