Smit Rupert D, Mouchtouris Nikolaos, Kang KiChang, Reyes Maikerly, Sathe Anish, Collopy Sarah, Prashant Giyarpuram, Yuan Hsiangkuo, Evans James J
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
J Neurol Neurosurg Psychiatry. 2023 Jan;94(1):49-56. doi: 10.1136/jnnp-2022-329588. Epub 2022 Aug 17.
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA) are disabling primary headache disorders. The advent of advanced imaging technologies and surgical techniques has translated to a growing arsenal of interventional therapies capable of treating headache disorders. This literature review sheds light on the current evidence available for interventional therapies in medically intractable SUNCT/SUNA. PubMed and EMBASE were searched for publications between 1978 and 2022. Inclusion criteria were SUNCT/SUNA studies reporting outcomes following occipital nerve stimulation (ONS), pulsed radiofrequency (PRF) of sphenopalatine ganglion (SPG), stereotactic radiosurgery (SRS), deep brain stimulation (DBS) or microvascular decompression (MVD) of the trigeminal nerve. A greater than 50% reduction in severity or a greater than 50% reduction in the number of attacks was defined as a successful response. The rate of successful responses for the various treatment modalities were as follows: ONS 33/41 (80.5%), PRF of SPG 5/9 (55.6%), DBS of the ventral tegmental area 14/16 (86.7%), SRS to the SPG and/or trigeminal nerve 7/9 (77.8%) and MVD 56/73 (76.7%). Mean follow-up time in months was 42.5 (ONS), 24.8 (PRF), 25.3 (DBS), 20.8 (SRS) and 42.4 (MVD). A significant proportion of SUNCT/SUNA patients remain refractory to medical therapy (45%-55%). This review discusses existing literature on interventional approaches, including neuromodulation, radiofrequency ablation, gamma knife radiosurgery and MVD. The outcomes are promising, yet limited data exist, underscoring the need for further research to develop a robust surgical management algorithm.
伴有结膜充血和流泪的短暂性单侧神经痛样头痛发作（SUNCT）以及伴有自主神经症状的短暂性单侧神经痛样头痛（SUNA）是使人致残的原发性头痛疾病。先进成像技术和外科技术的出现带来了越来越多能够治疗头痛疾病的介入治疗手段。这篇文献综述阐明了目前可用于药物难治性SUNCT/SUNA介入治疗的证据。在PubMed和EMBASE数据库中检索了1978年至2022年间的出版物。纳入标准为报告枕神经刺激（ONS）、蝶腭神经节（SPG）脉冲射频（PRF）、立体定向放射外科（SRS）、深部脑刺激（DBS）或三叉神经微血管减压术（MVD）后结果的SUNCT/SUNA研究。严重程度降低超过50%或发作次数减少超过50%被定义为成功反应。各种治疗方式的成功反应率如下：ONS为33/41（80.5%），SPG的PRF为5/9（55.6%），腹侧被盖区的DBS为14/16（86.7%），SPG和/或三叉神经的SRS为7/9（77.8%），MVD为56/73（76.7%）。平均随访时间以月为单位分别为42.5（ONS）、24.8（PRF）、25.3（DBS）、20.8（SRS）和42.4（MVD）。相当一部分SUNCT/SUNA患者对药物治疗仍有抵抗性（45%-55%）。本综述讨论了关于介入方法的现有文献，包括神经调节、射频消融、伽玛刀放射外科和MVD。结果很有前景，但数据有限，突出了进一步研究以制定完善的手术管理算法的必要性。
