Department of Neurosurgery, Heinrich-Heine-Universität Düsseldorf, Dusseldorf, Germany.
Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine-Universität Düsseldorf, Dusseldorf, Germany.
Neuromodulation. 2021 Dec;24(8):1429-1438. doi: 10.1111/ner.13261. Epub 2020 Sep 8.
Sphenopalatine ganglion (SPG) stimulation is an efficient treatment for cluster headache. The target for the SPG microstimulator in the pterygopalatine fossa lies between the vidian canal and foramen rotundum, ideally two contacts should be placed in this area. However, placement according to the manufacturers recommendations is frequently not possible. It is not known whether a suboptimal electrode placement interferes with postoperative outcomes.
SPG stimulation was performed in 13 patients between 2015 and 2018 in a single center. Lead location was determined by intraoperative computed tomography scan and correlated with the planned lead position as well as clinical data and stimulation parameters. Patients with a reduction of 50% or more in pain intensity or frequency were considered responsive.
Eleven patients (84.6%) responded to SPG stimulation with eight being frequency responders (61.5%). In seven cases, there were less than two electrodes between vidian canal and foramen rotundum, there was no significant correlation with negative stimulation results (p = 0.91). The mean distance of lead location between pre- and postoperative images did not correlate with clinical outcomes (p = 0.84) and was even bigger in responders (4.91 mm vs. 4.53 mm). The closest electrode contact to the vidian canal was in the stimulation area in all but one patient, regardless of its overall distance to canal. The distance of the closest electrode to the vidian canal was, however, not significantly correlated to the percentage of frequency (p = 0.68) or intensity reduction (p = 0.61).
There was no significant correlation regarding aberrations of lead position from the planned position with clinical outcome. However, this study might be underpowered to detect such a correlation. The closest electrode contact to the vidian canal was in the stimulation area in all but one patient in the final programming. This indicates that, overall, the lead location does play a crucial role in SPG stimulation for cluster headache.
蝶腭神经节（SPG）刺激是治疗丛集性头痛的有效方法。翼腭窝内 SPG 微刺激器的目标位于翼管和圆孔之间，理想情况下应在该区域放置两个触点。然而，按照制造商的建议进行放置通常是不可能的。目前尚不清楚电极放置不当是否会影响术后结果。
2015 年至 2018 年，在一家单中心对 13 名患者进行了 SPG 刺激。通过术中计算机断层扫描确定导联位置，并将其与计划的导联位置以及临床数据和刺激参数进行相关。疼痛强度或频率降低 50%或更多的患者被认为有反应。
11 名患者（84.6%）对 SPG 刺激有反应，其中 8 名是频率反应者（61.5%）。在 7 例中，翼管和圆孔之间的电极少于两个，但与负面刺激结果无显著相关性（p=0.91）。术前和术后图像的导联位置平均距离与临床结果无相关性（p=0.84），且在反应者中更大（4.91mm 与 4.53mm）。在所有患者中，除 1 例外，最接近翼管的电极接触点都在刺激区域，而不管其与翼管的总距离如何。然而，最接近翼管的电极距离与频率减少的百分比（p=0.68）或强度减少的百分比（p=0.61）无显著相关性。
导联位置与临床结果的偏离与临床结果无显著相关性。然而，本研究可能没有足够的能力来检测这种相关性。在最终编程中，除 1 例外，所有患者最接近翼管的电极接触点都在刺激区域。这表明，总体而言，导联位置在蝶腭神经节刺激治疗丛集性头痛中起着至关重要的作用。
