Deep brain stimulation modulates hypothalamic-brainstem fibers in cluster headache: case report

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  • 1 Department of Neurosurgery, Federal University of Rio Grande do Norte, Natal;
  • | 2 Department of Neurology, University of São Paulo Medical School, São Paulo;
  • | 3 Department of Internal Medicine, Onofre Lopes University Hospital, Natal, Brazil;
  • | 4 Extension Center, University of California, Davis, California; and
  • | 5 Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Hypothalamic deep brain stimulation (DBS) has been used for more than a decade to treat cluster headache (CH) but its mechanisms remain poorly understood. The authors have successfully treated a patient with CH using hypothalamic DBS and found that the contact used for chronic stimulation was located in a white matter region posterior to the mammillary bodies. Fiber tracts crossing that region were the medial forebrain bundle and those interconnecting the hypothalamus and brainstem, including the dorsal longitudinal fasciculus. Because the stimulation of axons is an important mechanism of DBS, some of its clinical effects in CH may be related to the stimulation of fibers interconnecting the hypothalamus and brainstem.

ABBREVIATIONS

CH = cluster headache; DBS = deep brain stimulation; DTI = diffusion tensor imaging; SPG = sphenopalatine ganglion; VTA = ventral tegmental area.

An artists depiction of a proposed method to deliver endovascular care via a teleoperated robot in space. A patient located on a satellite orbiting the Earth is undergoing a telesurgical endovascular intervention via the CorPath device. Real-time angiography images are beamed back to Earth, where an operator (in this case, a humanoid robot) is controlling the robot over a long distance. Copyright Gavin W. Britz. Published with permission. See the article by Panesar et al. (pp 971–978).

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