Reduced limbic connections may contraindicate subgenual cingulate deep brain stimulation for intractable depression.

Abstract:

:In this study, the authors performed deep brain stimulation (DBS) of the subgenual anterior cingulate cortex (SACC) in a patient with a history of bipolar disorder. After a right thalamic stroke, intractable depression without mood elevation or a mixed state developed in this patient. He underwent bilateral SACC DBS and died 16 months afterwards. Anatomical connections were studied in this patient preoperatively and postmortem using diffusion tractography (DT). A comparison of in vivo and high resolution ex vivo connectivity patterns was performed as a measure of the utility of in vivo DT in presurgical planning for DBS. Diagnostic measures included neuropsychological testing, preoperative and ex vivo DT, and macroscopic neuropathological assessment. Post-DBS depression rating scores did not improve. In vivo and ex vivo DT revealed markedly reduced limbic projections from the thalamus and SACC to the amygdala in the right (stroke-affected) hemisphere. A highly selective right mediothalamic lesion was associated with the onset of refractory depression. Reduced amygdalar-thalamic and amygdalar-SACC connections could be a contraindication to DBS for depression. Correspondence between preoperative and higher resolution ex vivo DT supports the validity of DT as a presurgical planning tool for DBS.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

McNab JA,Voets NL,Jenkinson N,Squier W,Miller KL,Goodwin GM,Aziz TZ

doi

10.3171/2009.2.JNS081299

subject

Has Abstract

pub_date

2009-10-01 00:00:00

pages

780-4

issue

4

eissn

0022-3085

issn

1933-0693

journal_volume

111

pub_type

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