A connectomic approach for subcallosal cingulate deep brain stimulation surgery: prospective targeting in treatment-resistant depression.
A connectomic approach for subcallosal cingulate deep brain stimulation surgery: prospective targeting in treatment-resistant depression.
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DOI：
10.1038/mp.2017.59
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发表时间：
2018-04
影响因子：
11
通讯作者：
Mayberg HS
中科院分区：
文献类型：
--
作者：
Riva-Posse P;Choi KS;Holtzheimer PE;Crowell AL;Garlow SJ;Rajendra JK;McIntyre CC;Gross RE;Mayberg HS
靶点识别和联系人选择是深部脑刺激手术不同临床适应症疗效差异的已知因素。对扣带回深部脑刺激(SCC DBS)治疗抑郁症的应答者的回顾分析表明，电刺激对聚集的白质束(小钳子、钩状束、扣带和额纹状体纤维)的刻板连接有共同的影响。为了测试一种用于SCC DBS手术的前瞻性连接方法的实用性，这项先导性研究使用了四束纤维束造影术“连接组蓝图”来计划11名患有难治性抑郁症的参与者的手术靶向。手术前，使用确定性的纤维束造影术逐个选择靶点。通过将每个受试者的术后概率纤维束造影图与术前确定性纤维束造影术图谱进行匹配，选择用于慢性刺激的接触者。术中行为反应作为定位的二次验证。所有参与者的概率路线图表明，按照预期包括了四个捆绑包，与先前定义的连接组蓝图相匹配。11例患者中有8例(72.7%)在6个月的开放标签刺激后有反应，5例有汇款。在一年中，11名患者中有9名(81.8%)是应答者，其中6人处于缓解状态。这些结果支持使用群体概率纤维束造影术地图作为个性化、患者特定、确定性的纤维束造影术靶向的连接体蓝图，证实了先前发表的回顾性研究结果。这一新方法代表了一种指导未来鳞状细胞癌DBS研究的连接方法。
Target identification and contact selection are known contributors to variability in efficacy across different clinical indications of deep brain stimulation surgery. A retrospective analysis of responders to subcallosal cingulate deep brain stimulation (SCC DBS) for depression demonstrated the common impact of the electrical stimulation on a stereotypic connectome of converging white matter bundles (forceps minor, uncinate fasciculus, cingulum and fronto-striatal fibers). To test the utility of a prospective connectomic approach for SCC DBS surgery, this pilot study used the four-bundle tractography “connectome blueprint” to plan surgical targeting in eleven participants with treatment-resistant depression. Before surgery, targets were selected individually using deterministic tractography. Selection of contacts for chronic stimulation was made by matching the postoperative probabilistic tractography map to the presurgical deterministic tractography map for each subject. Intraoperative behavioral responses were used as a secondary verification of location. A probabilistic tract map of all participants demonstrated inclusion of the four bundles as intended, matching the connectome blueprint previously defined. Eight of 11 patients (72.7%) were responders and 5 were remitters after 6 months of open-label stimulation. At one year, nine of 11 patients (81.8%) were responders, with six of them in remission. These results support the utility of a group probabilistic tractography map as a connectome blueprint for individualized, patient-specific, deterministic tractography targeting, confirming retrospective findings previously published. This new method represents a connectomic approach to guide future SCC DBS studies.
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影响因子：
5.7
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