Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting Clinical article
Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting Clinical article
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DOI：
10.3171/2008.10.jns08763
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发表时间：
2009-12-01
影响因子：
4.1
通讯作者：
Lozano, Andres M.
中科院分区：
文献类型：
--
作者：
Hamani, Clement;Mayberg, Helen;Lozano, Andres M.
Object.包括Brodmann 25区在内的胼胝体下扣带回（SCG）的脑深部电刺激（DBS）目前正在研究用于治疗重度抑郁症（MDD）。作为一种潜在的新兴疗法，SCG内的最佳靶点选择仍有待确定。作者比较了SCG DBS应答者和无应答者的电极触点位置，并将结果与临床结局相关联，以帮助识别该区域内的最佳靶点。基于用于应答者长期刺激的有源触点的位置，作者提出了一种针对MDD患者SCG的标准化方法。分析了20例经SCG DBS治疗的MDD患者的术后MRI检查结果。作者评估了主动触点相对于中连合点和额叶内侧解剖标志的位置。为此，设计了具有2条主线的网格，其中1条线在前后轴上，1条线在背腹轴上。将这些行中的每一行分成100个单位，并将数据转换为百分比。前后线从前连合（AC）延伸至胼胝体前部（CCa）的投影。背腹线从CC的下部（CCi）延伸到额叶的最腹侧（公式缩写为Fr）。由于手术技术在患者之间没有差异，因此应答者和无应答者之间的立体定向坐标在任何轴（x、y或z）上的差异均不超过1.5 mm。在对手术有反应的患者中，用于长期刺激的触点在SCG内非常接近。在前后线中，这些接触位于距AC的73.2 +/- 7.7百分位数距离内（AC中心为0%，穿过CCa的线为100%）。在背腹线中，应答者的活动触点位于距CCi 26.2 +/- 13.8百分位数的距离内（CCi边缘为0%，Fr下限为100%）。在内外侧平面上，大多数电极尖端位于SCG的灰质和白色物质之间的过渡区。对DBS有反应的患者中的主动接触者相对集中在SCG内。由于SCG大小和形状的解剖变异性，作者开发了一种方法来标准化该区域的靶向。(DOI：10.3171/2008.10.JNS08763）
Object. Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG), including Brodmann area 25, is currently being investigated for the treatment of major depressive disorder (MDD). As a potential emerging therapy, optimal target selection within the SCG has still to be determined. The authors compared the location of the electrode contacts in responders and nonresponders to DBS of the SCG and correlated the results with clinical outcome to help in identifying the optimal target within the region. Based on the location of the active contacts used for long-term stimulation in responders, the authors suggest a standardized method of targeting the SCG in patients with MDD.Methods. Postoperative MR imaging studies of 20 patients with MDD treated with DBS of the SCG were analyzed. The authors assessed the location of the active contacts relative to the midcommissural point and in relation to anatomical landmarks within the medial aspect of the frontal lobe. For this, a grid with 2 main lines was designed, with 1 line in the anterior-posterior and 1 line in the dorsal-ventral axis. Each of these lines was divided into 100 units, and data were converted into percentages. The anterior-posterior line extended from the anterior commissure (AC) to the projection of the anterior aspect of the corpus callosum (CCa). The dorsal-ventral line extended from the inferior portion of the CC (CCi) to the most ventral aspect of the frontal lobe (abbreviated "Fr" for the formula).Results. Because the surgical technique did not vary across patients, differences in stereotactic coordinates between responders and nonresponders did not exceed 1.5 mm in any axis (x, y, or z). In patients who responded to the procedure, contacts used for long-term stimulation were in close approximation within the SCG. In the anterior-posterior line, these contacts were located within a 73.2 +/- 7.7 percentile distance from the AC (with the AC center being 0% and the line crossing the CCa being 100%). In the dorsal-ventral line, active contacts in responders were located within a 26.2 +/- 13.8 percentile distance from the CCi (with the CCi edge being 0% and the Fr inferior limit being 100%). In the medial-lateral plane, most electrode tips were in the transition between the gray and white matter of SCG.Conclusions. Active contacts in patients who responded to DBS were relatively clustered within the SCG. Because of the anatomical variability in the size and shape of the SCG, the authors developed a method to standardize the targeting of this region. (DOI: 10.3171/2008.10.JNS08763)