DBS of the Third Ventricle Using a Floating Electrode to Treat Cluster Headaches: Proof of Concept

Keywords: cluster headache, electrode, headache, pain, deep brain stimulation

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     The third ventricle (V3) is surrounded by various centers related to satiety, homeostasis, hormones, sleep, memory and pain. However, accessing the V3 to stimulate its wall has not been studied and could have potential advantage to treat disorders related to dysfunction of the hypothalamus.
     Here we present our preliminary experience of V3 electrical stimulation using a floating DBS lead laid on the floor of the V3 to treat refractory cluster headaches (CH).
     We enrolled 5 patients suffering from CH in this pilot study.
     Targetting was based on MRI that was fused with ventriculography. The target was as follow; AP: 1/4 of AC-PC length anterior to PC, laterality: 0; high: floor of the V3. Under general anesthesia, a stereotactic frame was placed and one electrode was inserted trough a right frontal entry point and was lowered into the lateral horn of the ventricle up to the anterior V. Then, under tele-Xray ventriculoscopy guidance, the lead was oriented posteriorly and laid on the floor of the V3.
     Insertion of the lead into the V3 required some technical adjustment but was feasible and safe. No complications occurred during surgery and during follow up. Acute stimulation induced transient blurring vision. Chronic stimulation was set at 1-1.5 v, 130 Hz, 90 ms. At one year follow up, 3/5 patients were pain free, 1/5 had 75% improvement and 1/5 was improved by 25 %.
     This is a retrospective study.
     This proof of concept demonstrates the feasibility, safety and potential efficacy of V3-DBS using a transventricular road.
     The concept could be applied for various diseases.


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