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Related Concept Videos

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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
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Neuromodulation in cluster headache.

Denys Fontaine1, Clair Vandersteen, Delphine Magis

  • 1Department of Neurosurgery, Centre Hospitalier Universitaire de Nice, Nice, France, fontaine.d@chu-nice.fr.

Advances and Technical Standards in Neurosurgery
|November 21, 2014
PubMed
Summary
This summary is machine-generated.

Surgical treatments for chronic cluster headache (CH) show varied efficacy. Occipital nerve stimulation (ONS) and deep brain stimulation (DBS) offer promising results for refractory CH, with ONS recommended before DBS.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Headache Medicine

Background:

  • Medically refractory chronic cluster headache (CH) is a debilitating neurological disorder.
  • Existing surgical treatments lack controlled evaluations and long-term efficacy data.
  • Previous destructive procedures and microvascular decompression carry significant risks and limited sustained benefits.

Purpose of the Study:

  • To review and compare the efficacy and safety of various surgical interventions for chronic cluster headache.
  • To provide guidance on the appropriate sequencing of surgical treatments based on current evidence.

Main Methods:

  • Review of existing literature on surgical procedures for chronic cluster headache.
  • Analysis of reported outcomes, including attack frequency reduction and complication rates.
  • Comparison of deep brain stimulation (DBS), occipital nerve stimulation (ONS), and sphenopalatine ganglion (SPG) stimulation.

Main Results:

  • Occipital nerve stimulation (ONS) demonstrated >50% attack frequency reduction in approximately 70% of 60 reported patients with a low complication rate.
  • Deep brain stimulation (DBS) achieved >50% attack frequency reduction in 60% of 52 reported patients, with infrequent but serious complications.
  • Destructive procedures and microvascular decompression showed short-term improvement but lacked long-term efficacy and carried high risks.

Conclusions:

  • Occipital nerve stimulation (ONS) should be considered the first-line surgical option for medically refractory chronic cluster headache due to its favorable risk-benefit profile.
  • Deep brain stimulation (DBS) is a viable second-line option for patients who fail ONS.
  • Newer approaches like on-demand SPG stimulation require further investigation for long-term safety and efficacy.