Content area
Full text
Acta Neurochir (Wien) (2008) 150:9331012 DOI 10.1007/s00701-008-0030-6
ABSTRACTS
Abstracts of the Proceedings of the XVIIIth Congress of the European Society for Stereotactic and Functional Neurosurgery (ESSFN)
58 October 2008, Rimini, Italy
Cluster Headache
01. Sustained blood pressure changes with periventricular grey but not posterior hypothalamic deep brain stimulationE. A. C. Pereira, T. Dobbs, M. L. Kringelbach, D. J. Paterson,T. Z. Aziz, and A. L. Green
University of Oxford, Oxford, UK
Introduction. Deep brain stimulation (DBS) of the periaqueductal and periventricular grey matter (PAG/PVG) is an effective treatment for chronic pain. Similarly DBS of the posterior hypothalamus (PH) can treat chronic cluster headache. Both PAG/PVG and PH are established modulators of interoception and autonomic control, preliminary evidence suggesting transient changes in blood pressure (BP) with DBS dependent upon electrode location. Here we evaluate whether such changes are sustained.
Methods. Prospective investigation was undertaken of seven patients. Five had PAG/PVG DBS (2 of whom also had additional thalamic DBS) and two received PH DBS. Ambulatory BP and heart rate monitoring was conducted for consecutive 24-h periods with and without analgesic stimulation.
Results. Of the five patients receiving PAG/PVG stimulation, four had a sustained decrease in BP, mean arterial pressure falling from 95.1 to 87.9 mmHg, p<0.001, with marginal decreases in heart rate and pulse pressure. One showed a sustained rise in mean arterial pressure from 86.8 to 95.7 mmHg. Differences were found to be location-dependent. PH stimulation produced qualitative non-significant changes in BP, mean arterial pressure falling from 87.5 to 84.6 mmHg.
Conclusions. BP changes with PVG/PAG DBS appear to be sustained and dependent upon the target within the target, dorsal positioning increasing and ventral locations decreasing BP. Pain relief may contribute to BP changes, however the lack of significant BP changes with PH DBS despite freedom from pain argues for an independent mechanism.
02. Anatomical location of effective contacts in patients with chronic cluster headache treated by deepbrain stimulationD. Fontaine1, M. Lanteri-Minet1, Y. Lazorthes2, P. Mertens3,S. Blond4, and J. J. Lemaire5
1CHU de Nice, Nice, France ; 2CHU de Toulouse, Toulouse, France; 3Hospices Civils de Lyon, Lyon, France; 4CHU de Lille, Lille, France; 5CHU de Clermont-Ferrand, Clermont-Ferrand, France
Introduction. We report the anatomical location of effective stimulating electrode contacts in patients with therapy-resistant chronic cluster headache...