Connectivity of an effective hypothalamic surgical target for cluster headache.
The purpose of this study was to look at the connectivity of the posterior inferior hypothalamus in a patient implanted with a deep brain stimulating electrode using probabilistic tractography in conjunction with postoperative MRI scans. In a patient with chronic cluster headache we implanted a deep brain stimulating electrode into the ipsilateral postero-medial hypothalamus to successfully control his pain. To explore the connectivity, we used the surgical target from the postoperative MRI scan as a seed for probabilistic tractography, which was then linked to diffusion weighted imaging data acquired in a group of healthy control subjects. We found highly consistent connections with the reticular nucleus and cerebellum. In some subjects, connections were also seen with the parietal cortices, and the inferior medial frontal gyrus. Our results illustrate important anatomical connections that may explain the functional changes associated with cluster headaches and elucidate possible mechanisms responsible for triggering attacks.
Owen
S L F
SL
University Laboratory of Physiology, University of Oxford, Oxford, UK.
Green
A L
AL
Davies
P
P
Stein
J F
JF
Aziz
T Z
TZ
Behrens
T
T
Voets
N L
NL
Johansen-Berg
H
H
D001341:Autonomic Nervous System / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D001683:Biological Clocks / Q000502:physiology; D001931:Brain Mapping / Q000379:methods*; D001933:Brain Stem / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D002531:Cerebellum / Q000033:anatomy & histology / Q000503:physiopathology; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D003027:Cluster Headache / Q000503:physiopathology* / Q000628:therapy; D046690:Deep Brain Stimulation / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004525:Efferent Pathways / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D004567:Electrodes, Implanted / Q000592:standards; D006801:Humans; D007027:Hypothalamic Diseases / Q000503:physiopathology* / Q000628:therapy; D007034:Hypothalamus, Posterior / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009415:Nerve Net / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D012154:Reticular Formation / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed