Anatomical location of effective deep brain stimulation electrodes in chronic cluster headache

Deep brain stimulation of the posterior hypothalamus is a therapeutic approach to the treatment of refractory chronic cluster headache, but the precise anatomical location of the electrode contacts has not been clearly assessed. Our aim was to study the location of the contacts used for chronic stim...

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Veröffentlicht in:Brain (London, England : 1878) England : 1878), 2010-04, Vol.133 (4), p.1214-1223
Hauptverfasser: Fontaine, Denys, Lanteri-Minet, Michel, Ouchchane, Lemlih, Lazorthes, Yves, Mertens, Patrick, Blond, Serge, Geraud, G., Fabre, Nelly, Navez, Malou, Lucas, Christian, Dubois, Francois, Sol, Jean Christophe, Paquis, Philippe, Lemaire, Jean Jacques
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Sprache:eng
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Zusammenfassung:Deep brain stimulation of the posterior hypothalamus is a therapeutic approach to the treatment of refractory chronic cluster headache, but the precise anatomical location of the electrode contacts has not been clearly assessed. Our aim was to study the location of the contacts used for chronic stimulation, projecting each contact centre on anatomic atlases. Electrodes were implanted in a series of 10 patients (prospective controlled trial) in the so-called ‘posteroinferior hypothalamus’ according to previously described coordinates, i.e. 2 mm lateral, 3 mm posterior and 5 mm below the mid-commissural point. The coordinates of the centre of each stimulating contact were measured on postoperative computed tomography or magnetic resonance imaging scans, taking into account the artefact of the electrode. Each contact centre (n = 10; left and right hemispheres pooled) was displayed on the Schaltenbrand atlas and a stereotactic three dimensional magnetic resonance imaging atlas (4.7 tesla) of the diencephalon–mesencephalic junction for accurate anatomical location. Of the 10 patients with 1-year follow-up, 5 responded to deep brain stimulation (weekly frequency of attacks decrease >50%). In responders, the mean (standard deviation) coordinates of the contacts were 2.98 (1.16) mm lateral, 3.53 (1.97) mm posterior and 3.31 (1.97) mm below the mid-commissural point. All the effective contacts were located posterior to the hypothalamus. In responders, structures located
ISSN:0006-8950
1460-2156
DOI:10.1093/brain/awq041