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Multi-tensor investigation of orbitofrontal cortex tracts affected in subcaudate tractotomy

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Abstract

Subcaudate tractotomy (SCT) is a neurosurgical lesioning procedure that can reduce symptoms in medically intractable obsessive compulsive disorder (OCD). Due to the putative importance of the orbitofrontal cortex (OFC) in symptomatology, fibers that connect the OFC, SCT lesion, and either the thalamus or brainstem were investigated with two-tensor tractography using an unscented Kalman filter approach. From this dataset, fibers were warped to Montreal Neurological Institute space, and probability maps with center-of-mass analysis were subsequently generated. In comparing fibers from the same OFC region, including medial OFC (mOFC), central OFC (cOFC), and lateral OFC (lOFC), the area of divergence for fibers connected with the thalamus versus the brainstem is posterior to the anterior commissure. At the anterior commissure, fibers connected with the thalamus run dorsal to those connected with the brainstem. As OFC fibers travel through the ventral aspect of the internal capsule, lOFC fibers are dorsal to cOFC and mOFC fibers. Using neuroanatomical comparison, tracts coursing between the OFC and thalamus are likely part of the anterior thalamic radiations, while those between the OFC and brainstem likely belong to the medial forebrain bundle. These data support the involvement of the OFC in OCD and may be relevant to creating differential lesional procedures of specific tracts or to developing deep brain stimulation programming paradigms.

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Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

Funding sources

R01DA027804 (NM), R21EB016449 (NM)

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Jimmy C. Yang, George Papadimitriou, Ryan Eckbo, Edward H. Yeterian, Lichen Liang, Darin D. Dougherty, Sylvain Bouix, Yogesh Rathi, Martha Shenton, Marek Kubicki, Emad N. Eskandar, and Nikos Makris confirm adherence to ethical research standards and report no conflicts of interest or personal commercial or financial interest in any of the materials or devices described.

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Authors and Affiliations

  1. Departments of Psychiatry and Neurology, Center for Morphometric Analysis, A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA

    George Papadimitriou, Lichen Liang & Nikos Makris

  2. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA

    Jimmy C. Yang & Emad N. Eskandar

  3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Darin D. Dougherty

  4. Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Boston, MA, USA

    Ryan Eckbo, Sylvain Bouix, Yogesh Rathi, Martha Shenton & Marek Kubicki

  5. Harvard Medical School, Boston, MA, USA

    Jimmy C. Yang, Darin D. Dougherty, Sylvain Bouix, Yogesh Rathi, Martha Shenton, Marek Kubicki, Emad N. Eskandar & Nikos Makris

  6. Department of Psychology, Colby College, Waterville, ME, USA

    Edward H. Yeterian

  7. VA Boston Healthcare System, Brockton, MA, USA

    Martha Shenton

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Emad N. Eskandar and Nikos Makris contributed equally to this work

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Yang, J.C., Papadimitriou, G., Eckbo, R. et al. Multi-tensor investigation of orbitofrontal cortex tracts affected in subcaudate tractotomy. Brain Imaging and Behavior 9, 342–352 (2015). https://doi.org/10.1007/s11682-014-9314-z

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