The objective of this study is to describe the
therapeutic effect and the technical and surgical problems of
deep brain stimulation (DBS) of the posterior hypothalamus over seven years, for treatment of chronic
trigeminal autonomic cephalalgias and atypical
facial pain. We report a surgical series of 20 patients that underwent DBS of the posterior hypothalamus. This series includes 16 patients with
chronic cluster headache (CH), one patient with short-lasting unilateral neuralgiform
headache attacks with conjunctival injection and tearing (SUNCT) and three patients with atypical
facial pain. All patients of this series were resistant to any pharmacological and
conservative treatment. The stimulated target was the same in the whole series even though stereotactic coordinates of the target referred to the midcommissural point differ slight in the Y anteroposterior value due to individual anatomical variability. The commissures based reference system was adapted to individual anatomical landmarks of the brainstem adding to the registration a third reference point below the commissural plane. The stimulation parameters of unipolar stimulation were similar in the whole series: 180 Hz, 60 mus, 1-3 V. In the CH series, at five years follow-up the percentage of total number of days free from
pain attacks improved from 1%-2% to 71%. Ten patients of this series had a complete and persistent
pain-free state at 18 months follow-up and the patient with SUNCT has complete
pain relief. In the three patients with atypical
facial pain, the neurostimulation procedure was absolutely unsuccessful. DBS of the posterior hypothalamus produced a significant and marked reduction of
pain bouts in CH patients and in the SUNCT patient. The attempts to treat atypical
facial pain in three patients failed.