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Nervenheilkunde 2005; 24(10): 936-939
DOI: 10.1055/s-0038-1630023
Original Article
Schattauer GmbH

Voraussetzungen für die hypothalamische Tiefenhirnstimulation bei Patienten mit chronischen Clusterkopfschmerzen

Hypothalamus deep-brain stimulation at patients with chronic cluster headache
A. May
1   Institut für systemische Neurowissenschaften, Universitätsklinik Hamburg Eppendorf
,
J. Vesper
2   Abteilung Stereotaktische Neurochirurgie Freiburg
,
W. Hamel
3   Neurochirurgische Universitätsklinik Hamburg Eppendorf
,
M. Westphal
3   Neurochirurgische Universitätsklinik Hamburg Eppendorf
,
C. Weiller
4   Neurologische Universitätsklinik Freiburg
,
G. Nikkhah
2   Abteilung Stereotaktische Neurochirurgie Freiburg
› Author Affiliations
Further Information

Publication History

Publication Date:
30 January 2018 (online)

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Zusammenfassung

Clusterkopfschmerzen zeichnen sich durch eine stereotype Symptomatik aus und gehören zu den schwersten primären Schmerzsyndromen. Bildgebungsstudien haben funktionelle und strukturelle Veränderungen im ipsilateral zum Schmerz gelegenen inferior-posterioren Hypothalamus nachgewiesen. Diese Veränderungen sind sehr spezifisch für das Syndrom und legen nahe, dass diese anatomische Region als Auslöser oder Generator der akuten Attacken und/oder der akuten Schmerzperioden fungiert. Diese Befunde führten dazu, dass einige nicht oder nur sehr schwer therapierbare Patienten einer hypothalamischen Tiefenhirnstimulation unterzogen wurden. Bislang wurden 19 Patienten erfolgreich behandelt, resultierend in zum Teil lang anhaltenden schmerzfreien Perioden, ohne dass wesentliche Nebenwirkungen auftraten. Vor kurzem wurde allerdings auch über einen Patienten berichtet, der auf Grund eines Blutdruckanstieges und nachfolgender Ruptur eines zuvor nicht diagnostizierten Aneurysmas, nach der Operation verstarb. Der folgende Artikel bietet eine zusammenfassende Übersetzung kürzlich publizierter Kriterien einer internationalen Konsensusgruppe (1), die neben einem positiven Ethikvotum erfüllt sein sollten, bevor eine Stimulation des Hypothalamus bei solchen Patienten erwogen wird.

Summary

Cluster headaches show a stereotypic pathology and belong to the most severe primary pain syndromes. Imaging studies have proven functional and structural changes in the inferior-posterior hypothalamus. These changes are very specific for this syndrome and demonstrate that this anatomical region triggers and generates acute attacks and/or acute periods of pain. These results lead to deepbrain treatment of the hypothalamus region of patients, who were not treated or were difficult to treat. Until now, 19 patients have been treated successfully without any significant side effects. Recently, the case of a patient, who died following an operation because of increased blood pressure and rupture due to an undiagnosed aneurysm was reported. The following article gives an overview of recently published criteria of an international consensus group (1), which should be fulfilled, before a deep-brain stimulation can be considered in these patients.

Schlüsselwörter

Clusterkopfschmerz - Tiefenhirnstimulation - Hypothalamus

Key words

Cluster headache - beep brain stimulation - hypothalamus
 

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