Tractography-Guided Anterior Capsulotomy for Major Depression and Obsessive-Compulsive Disorder: Targeting the Emotion Network

2021 ◽  
Author(s):  
Josue M Avecillas-Chasin ◽  
Trevor A Hurwitz ◽  
Nicholas M Bogod ◽  
Christopher R Honey
Keyword(s):  
Major Depression ◽  
Obsessive Compulsive Disorder ◽  
Internal Capsule ◽  
Treatment Resistant ◽  
High Definition ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Anterior Capsulotomy ◽  
Term Benefit

Abstract BACKGROUND Bilateral anterior capsulotomy (BAC) is an effective surgical option for patients with treatment-resistant major depression (TRMD) and treatment-resistant obsessive-compulsive disorder (TROCD). The size of the lesion and its precise dorsal-ventral location within the anterior limb of the internal capsule (ALIC) remain undefined. OBJECTIVE To present a method to identify the trajectories of the associative and limbic white matter pathways within the ALIC for targeting in BAC surgery. METHODS Using high-definition tractography, we prospectively tested the feasibility of this method in 2 patients with TRMD and TROCD to tailor the capsulotomy lesion to their limbic pathway. RESULTS The trajectories of the associative and limbic pathways were identified in the ALIC of both patients and we targeted the limbic pathways by defining the dorsal limit of the lesion in a way to minimize the damage to the associative pathways. The final lesions were smaller than those that have been previously published. This individualized procedure was associated with long-term benefit in both patients. CONCLUSION Tractography-guided capsulotomy is feasible and was associated with long-term benefit in patients with TRMD and TROCD.

Unilateral right anterior capsulotomy for refractory major depression with comorbid obsessive–compulsive disorder

Neurocase ◽  
2011 ◽  
Vol 17 (6) ◽  
pp. 491-500 ◽  
Author(s):  
Alonso R. Riestra ◽  
Jaime Aguilar ◽  
Gerardo Zambito ◽  
Gabriela Galindo y Villa ◽  
Fernando Barrios ◽  
...  
Keyword(s):  
Major Depression ◽  
Obsessive Compulsive Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Anterior Capsulotomy

scholarly journals Results Following Gamma Knife Radiosurgical Anterior Capsulotomies for Obsessive Compulsive Disorder

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Douglas. Kondziolka ◽  
John C. Flickinger ◽  
Robert. Hudak
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Internal Capsule ◽  
Severe Form ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Bilateral Lesions ◽  
Anterior Capsulotomy

Abstract BACKGROUND: Obsessive compulsive disorder (OCD), in its severe form, can cause tremendous disability for affected patients. OBJECTIVE: To evaluate the results following bilateral radiosurgical anterior capsulotomy for severe medically refractory OCD. METHODS: We performed gamma knife anterior capsulotomy (GKAC) on 3 patients with extreme, medically intractable OCD. According to our protocol, all patients were evaluated by at least 2 psychiatrists who recommended surgery. The patient had to request the procedure, and had to have severe OCD according to the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patient ages were 37, 55, and 40 years, and pre-radiosurgery YBOCS scores were 34/40, 39/40, and 39/40. Bilateral lesions were created with 2 4-mm isocenters to create an oval volume in the ventral internal capsule at the putaminal midpoint. A maximum dose of 140 or 150 Gy was used. RESULTS: There was no morbidity after the procedure, and all patients returned immediately to baseline function. All patients noted significant functional improvements, and reduction in OCD behavior. Follow-up was at 55, 42, and 28 months. The first patient reduced her YBOCS score from 34 to 24. One patient with compulsive skin picking and an open wound had later healing of the chronic wound and a reduction in the YBOCS score from 39 to 8. At 28 months, the third patient is living and working independently, and her YBOCS score is 18. CONCLUSION: Within a strict protocol, gamma knife radiosurgery provided improvement of OCD behavior with no adverse effects. This technique should be evaluated further in patients with severe and disabling behavioral disorders.

Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up

2013 ◽  
Vol 84 (11) ◽  
pp. 1208-1213 ◽  
Author(s):  
Myreille D'Astous ◽  
Sylvine Cottin ◽  
Martin Roy ◽  
Claude Picard ◽  
Léo Cantin
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Long Term Follow Up ◽  
Anterior Capsulotomy

Interstitial laser anterior capsulotomy for obsessive–compulsive disorder: lesion size and tractography correlate with outcome

2021 ◽  
pp. jnnp-2021-327730
Author(s):  
David Satzer ◽  
Anil Mahavadi ◽  
Maureen Lacy ◽  
Jon E Grant ◽  
Peter Warnke
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Internal Capsule ◽  
Lesion Size ◽  
Behavioural Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Ablation Volume ◽  
Cognitive Behavioural ◽  
Anterior Capsulotomy

BackgroundAnterior capsulotomy is a well-established treatment for refractory obsessive–compulsive disorder (OCD). MRI-guided laser interstitial thermal therapy (LITT) allows creation of large, sharply demarcated lesions with the safeguard of real-time imaging.ObjectiveTo characterise the outcomes of laser anterior capsulotomy, including radiographical predictors of improvement.MethodsPatients with severe OCD refractory to pharmacotherapy and cognitive–behavioural therapy underwent bilateral anterior capsulotomy via LITT. The primary outcome was per cent reduction in Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) score over time. Lesion size was measured on postablation MRI. Disconnection of the anterior limb of the internal capsule (ALIC) was assessed via individual and normative tractography.ResultsEighteen patients underwent laser anterior capsulotomy. Median follow-up was 6 months (range 3–51 months). Time occupied by obsessions improved immediately (median Y-BOCS item 1 score 4–1, p=0.002). Mean (±SD) decrease in Y-BOCS score at last follow-up was 46%±32% (16±11 points, p<0.0001). Sixty-one per cent of patients were responders. Seven patients (39%) exhibited transient postoperative apathy. One patient had an asymptomatic intracerebral haemorrhage. Reduction in Y-BOCS score was positively associated with ablation volume (p=0.006). Individual tractography demonstrated durable ALIC disconnection. Normative tractography revealed a dorsal–ventral gradient, with disconnection of orbitofrontal streamlines most strongly associated with a positive response (p<0.0001).ConclusionsLaser anterior capsulotomy resulted in immediate, marked improvement in OCD symptom severity. Larger lesions permit greater disconnection of prefrontal–subcortical pathways involved in OCD. The importance of greater disconnection is presumably related to variation in ALIC structure and the complex role of the PFC in OCD.

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