Operative und interventionelle Therapieverfahren beim Cluster-Kopfschmerz

Zusammenfassung

Cluster-Kopfschmerz ist manchmal schwer zu therapieren und bei völligem Versagen der medikamentösen Therapien existieren operative Ansätze des Trigeminus. Bekannt ist, dass die Rezidivrate für diese Verfahren hoch ist. Zusätzlich besteht die Gefahr dauernder Funktionseinbußen oder einer anaesthesia dolorosa. In manchen Fällen ist die Leitungsanästhesie des Nervus occipitalis major erfolgreich und sollte daher auch bei Patienten mit chronischem ClusterKopfschmerz vor einer invasiven Therapie versucht werden. Als Prinzip gilt, jegliche chirurgische Prozedur von peripheren trigeminalen Strukturen beim episodischen ClusterKopfschmerz mit großer Vorsicht zu beurteilen, da die Erkrankung per definitionem remittiert. Kürzlich wurde auf der Basis von Bildgebungsverfahren erfolgreich die hypothalamische Tiefenhirnstimulation eingesetzt. Da es sich um eine experimentelle Therapie handelt, sollten die publizierten internationalen Konsensusrichtlinien für diese Prozedur bekannt sein und angewandt werden.

Summary

If all drug treatment procedures are ineffective anda secondary cluster headache (CH) has been excluded, surgical treatment can be discussed with the patient. Surgical procedures should be considered with great caution because no reliable long term observational data are available and because they can induce trigeminal neuralgia or anaesthesia dolorosa. However, there are also case reports of the complete inefficacy of surgical treatment in cluster headache and related syndromes. In some cases, blockade of the greater occipital nerve was effective and may be tried before any other surgical procedure. In general, any surgical procedure on peripheral trigeminal structures in episodic CH has to be judged with great caution, as the nature of the disease is to remit. Very recently, deep brain stimulation of the posterior inferior hypothalamus has been shown to be effective in the majority ofa sample of patients with intractable cluster headache. Recommendations for the selection of patients for this procedure have been published recently.

Schlüsselwörter

Tiefenhirnstimulation - Cluster-Kopfschmerz - Trigeminoautonome Kopfschmerzen - Therapie - invasiv

Keywords

Deep brain stimulation - cluster headache - trigeminoautonomic headache - therapy - interventional

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