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Gamma-knife subcaudate tractotomy for treatment-resistant depression and target characteristics: a case report and review

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Abstract

Stereotactic subcaudate tractotomy has previously been suggested to be an effective treatment for depression. This is the first study to report the use of gamma-knife subcaudate tractotomy for treatment-resistant depression. A 49-year-old woman with major depressive disorder had been treated for 30 years, with nine suicide attempts during that time. The right and left target maximum diameter was 11 mm within 50 % isodose lines. The target was located more posteriorly and inferiorly than the subgenual cingulate target typically used for deep-brain stimulation. The maximum radiation dose was 130 Gy. During the 4 months after surgery, the patient improved gradually from 23 to 4 according to the Hamilton Rating Scale for Depression and antidepressant medication was discontinued. Target-sized focal lesions were identified and no edema was seen postoperatively. No aggravation or neurologic deficit occurred during the 2.5 years of follow-up. Gamma-knife subcaudate tractotomy for depression is a minimally invasive technique. Investigations of the effectiveness and safety profile in a larger group are warranted.

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References

  1. Abosch A, Cosgrove GR (2008) Biological basis for the surgical treatment of depression. Neurosurg Focus 25:E2

    Article  PubMed  Google Scholar 

  2. Bednarz G, Downes MB, Corn BW, Curran WJ, Goldman HW (1999) Evaluation of the spatial accuracy of magnetic resonance imaging-based stereotactic target localization for gamma knife radiosurgery of functional disorders. Neurosurgery 45:1156–1161, discussion 1161–1153

    Article  CAS  PubMed  Google Scholar 

  3. Bohr IJ, Kenny E, Blamire A, O’Brien JT, Thomas AJ, Richardson J, Kaiser M (2012) Resting-state functional connectivity in late-life depression: higher global connectivity and more long distance connections. Front Psych 3:116

    Google Scholar 

  4. Bourne SK, Sheth SA, Neal J, Strong C, Mian MK, Cosgrove GR, Eskandar EN, Dougherty DD (2013) Beneficial effect of subsequent lesion procedures after nonresponse to initial cingulotomy for severe, treatment-refractory obsessive-compulsive disorder. Neurosurgery 72:196–202, discussion 202

    Article  PubMed  Google Scholar 

  5. Bridges PK, Bartlett JR, Hale AS, Poynton AM, Malizia AL, Hodgkiss AD (1994) Psychosurgery: stereotactic subcaudate tractomy. An indispensable treatment. Br J Psychiatry 165:599–611, discussion 612–593

    Article  CAS  PubMed  Google Scholar 

  6. Cauley KA, Waheed W, Salmela M, Filippi CG (2010) MR imaging of psychosurgery: rostral atrophy following stereotacic subcaudate tractotomy. Br J Radiol 83:e239–e242

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Constine LS, Woolf PD, Cann D, Mick G, McCormick K, Raubertas RF, Rubin P (1993) Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med 328:87–94

    Article  CAS  PubMed  Google Scholar 

  8. Dougherty DD, Rezai AR, Carpenter LL, Howland RH, Bhati MT, O’Reardon JP, Eskandar EN, Baltuch GH, Machado AD, Kondziolka D, Cusin C, Evans KC, Price LH, Jacobs K, Pandya M, Denko T, Tyrka AR, Brelje T, Deckersbach T, Kubu C, Malone DA Jr (2015) A randomized sham-controlled trial of deep brain stimulation of the ventral capsule/ventral striatum for chronic treatment-resistant depression. Biol Psychiatry 78:240–248

    Article  PubMed  Google Scholar 

  9. Friehs GM, Noren G, Ohye C, Duma CM, Marks R, Plombon J, Young RF (1996) Lesion size following gamma knife treatment for functional disorders. Stereotact Funct Neurosurg 66(Suppl 1):320–328

    PubMed  Google Scholar 

  10. Galvez JF, Keser Z, Mwangi B, Ghouse AA, Fenoy AJ, Schulz PE, Sanches M, Quevedo J, Selvaraj S, Gajwani P, Zunta-Soares G, Hasan KM, Soares JC (2015) The medial forebrain bundle as a deep brain stimulation target for treatment resistant depression: A review of published data. Prog Neuropsychopharmacol Biol Psychiatry 58:59–70

    Article  PubMed  Google Scholar 

  11. Girkin CA, Comey CH, Lunsford LD, Goodman ML, Kline LB (1997) Radiation optic neuropathy after stereotactic radiosurgery. Ophthalmology 104:1634–1643

    Article  CAS  PubMed  Google Scholar 

  12. Hamani C, Mayberg H, Snyder B, Giacobbe P, Kennedy S, Lozano AM (2009) Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting. J Neurosurg 111:1209–1215

    Article  PubMed  Google Scholar 

  13. Hodgkiss AD, Malizia AL, Bartlett JR, Bridges PK (1995) Outcome after the psychosurgical operation of stereotactic subcaudate tractotomy, 1979–1991. J Neuropsychiatry Clin Neurosci 7:230–234

    Article  CAS  PubMed  Google Scholar 

  14. Jimenez F, Nicolini H, Lozano AM, Piedimonte F, Salin R, Velasco F (2013) Electrical stimulation of the inferior thalamic peduncle in the treatment of major depression and obsessive compulsive disorders. World Neurosurg 80(S30):e17–e25

    Google Scholar 

  15. Kartsounis LD, Poynton A, Bridges PK, Bartlett JR (1991) Neuropsychological correlates of stereotactic subcaudate tractotomy. A prospective study. Brain 114(Pt 6):2657–2673

    Article  PubMed  Google Scholar 

  16. Kier EL, Staib LH, Davis LM, Bronen RA (2004) MR imaging of the temporal stem: anatomic dissection tractography of the uncinate fasciculus, inferior occipitofrontal fasciculus, and Meyer’s loop of the optic radiation. AJNR Am J Neuroradiol 25:677–691

    PubMed  Google Scholar 

  17. Kihlstrom L, Hindmarsh T, Lax I, Lippitz B, Mindus P, Lindquist C (1997) Radiosurgical lesions in the normal human brain 17 years after gamma knife capsulotomy. Neurosurgery 41:396–401, discussion 401–392

    Article  CAS  PubMed  Google Scholar 

  18. Lassalle-Lagadec S, Sibon I, Dilharreguy B, Renou P, Fleury O, Allard M (2012) Subacute default mode network dysfunction in the prediction of post-stroke depression severity. Radiology 264:218–224

    Article  PubMed  Google Scholar 

  19. Lim HK, Jung WS, Aizenstein HJ (2013) Aberrant topographical organization in gray matter structural network in late life depression: a graph theoretical analysis. Int Psychogeriatr 25:1929–1940

    Article  PubMed  Google Scholar 

  20. Lopes AC, Greenberg BD, Canteras MM, Batistuzzo MC, Hoexter MQ, Gentil AF, Pereira CA, Joaquim MA, de Mathis ME, D’Alcante CC, Taub A, de Castro DG, Tokeshi L, Sampaio LA, Leite CC, Shavitt RG, Diniz JB, Busatto G, Noren G, Rasmussen SA, Miguel EC (2014) Gamma ventral capsulotomy for obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiatry 71:1066–1076

    Article  PubMed  Google Scholar 

  21. Malhi GS, Bartlett JR (1998) A new lesion for the psychosurgical operation of stereotactic subcaudate tractotomy (SST). Br J Neurosurg 12:335–339

    Article  CAS  PubMed  Google Scholar 

  22. Malhi GS, Bartlett JR (2000) Depression: a role for neurosurgery? Br J Neurosurg 14:415–422, discussion 423

    Article  CAS  PubMed  Google Scholar 

  23. Malone DA Jr, Dougherty DD, Rezai AR, Carpenter LL, Friehs GM, Eskandar EN, Rauch SL, Rasmussen SA, Machado AG, Kubu CS, Tyrka AR, Price LH, Stypulkowski PH, Giftakis JE, Rise MT, Malloy PF, Salloway SP, Greenberg BD (2009) Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry 65:267–275

    Article  PubMed  Google Scholar 

  24. Mayo C, Martel MK, Marks LB, Flickinger J, Nam J, Kirkpatrick J (2010) Radiation dose-volume effects of optic nerves and chiasm. Int J Radiat Oncol Biol Phys 76:S28–S35

    Article  PubMed  Google Scholar 

  25. Muller S, Riedmuller R, van Oosterhout A (2015) Rivaling paradigms in psychiatric neurosurgery: adjustability versus quick fix versus minimal-invasiveness. Front Integr Neurosci 9:27

    PubMed  PubMed Central  Google Scholar 

  26. Nuttin B, Wu H, Mayberg H, Hariz M, Gabriels L, Galert T, Merkel R, Kubu C, Vilela-Filho O, Matthews K, Taira T, Lozano AM, Schechtmann G, Doshi P, Broggi G, Regis J, Alkhani A, Sun B, Eljamel S, Schulder M, Kaplitt M, Eskandar E, Rezai A, Krauss JK, Hilven P, Schuurman R, Ruiz P, Chang JW, Cosyns P, Lipsman N, Voges J, Cosgrove R, Li Y, Schlaepfer T (2014) Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. J Neurol Neurosurg Psychiatry 85:1003–1008

    Article  PubMed  PubMed Central  Google Scholar 

  27. Paz JT, Huguenard JR (2015) Microcircuits and their interactions in epilepsy: is the focus out of focus? Nat Neurosci 18:351–359

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Regis J (2014) Gamma knife for functional diseases. Neurotherapeutics 11:583–592

    Article  PubMed  PubMed Central  Google Scholar 

  29. Riva-Posse P, Choi KS, Holtzheimer PE, McIntyre CC, Gross RE, Chaturvedi A, Crowell AL, Garlow SJ, Rajendra JK, Mayberg HS (2014) Defining critical white matter pathways mediating successful subcallosal cingulate deep brain stimulation for treatment-resistant depression. Biol Psychiatry 76:963–969

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sachdev PS, Sachdev J (2005) Long-term outcome of neurosurgery for the treatment of resistant depression. J Neuropsychiatry Clin Neurosci 17:478–485

    Article  PubMed  Google Scholar 

  31. Santacroce A, Kamp MA, Budach W, Hanggi D (2013) Radiobiology of radiosurgery for the central nervous system. Biomed Res Int 2013:362761

    Article  PubMed  PubMed Central  Google Scholar 

  32. Schoene-Bake JC, Parpaley Y, Weber B, Panksepp J, Hurwitz TA, Coenen VA (2010) Tractographic analysis of historical lesion surgery for depression. Neuropsychopharmacology 35:2553–2563

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shields DC, Asaad W, Eskandar EN, Jain FA, Cosgrove GR, Flaherty AW, Cassem EH, Price BH, Rauch SL, Dougherty DD (2008) Prospective assessment of stereotactic ablative surgery for intractable major depression. Biol Psychiatry 64:449–454

    Article  PubMed  Google Scholar 

  34. Steele JD, Christmas D, Eljamel MS, Matthews K (2008) Anterior cingulotomy for major depression: clinical outcome and relationship to lesion characteristics. Biol Psychiatry 63:670–677

    Article  PubMed  Google Scholar 

  35. Uchino A, Kato A, Yuzuriha T, Takashima Y, Kudo S (2001) Cranial MR imaging of sequelae of prefrontal lobotomy. AJNR Am J Neuroradiol 22:301–304

    CAS  PubMed  Google Scholar 

  36. Woerdeman PA, Willems PW, Noordmans HJ, Berkelbach van der Sprenkel JW, van Rijen PC (2006) Frameless stereotactic subcaudate tractotomy for intractable obsessive-compulsive disorder. Acta Neurochir (Wien) 148:633–637, discussion 637

    Article  CAS  Google Scholar 

  37. Yang JC, Ginat DT, Dougherty DD, Makris N, Eskandar EN (2014) Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes. J Neurosurg 120:152–163

    Article  PubMed  Google Scholar 

  38. Young RF, Jacques S, Mark R, Kopyov O, Copcutt B, Posewitz A, Li F (2000) Gamma knife thalamotomy for treatment of tremor: long-term results. J Neurosurg 93(Suppl 3):128–135

    PubMed  Google Scholar 

  39. Young RF, Shumway-Cook A, Vermeulen SS, Grimm P, Blasko J, Posewitz A, Burkhart WA, Goiney RC (1998) Gamma knife radiosurgery as a lesioning technique in movement disorder surgery. J Neurosurg 89:183–193

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Professor Yong-Wook Shin in the Department of Psychiatry, Asan Medical Center for the final clinical follow-up and psychiatric examinations for the reported patient.

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Authors and Affiliations

  1. Department of Neurosurgery, Asan Medical Center, 88, Olympic Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Seong-Cheol Park, Jung Kyo Lee & Do Hee Lee

  2. College of Medicine, University of Ulsan, 88, Olympic Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Jung Kyo Lee & Jin Pyo Hong

  3. Department of Psychiatry, Severance Hospital, Yonsei University, Seoul, Korea

    Chan-Hyung Kim

  4. Department of Psychiatry, Asan Medical Center, Seoul, Korea

    Jin Pyo Hong

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  1. Seong-Cheol Park
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Correspondence to Jung Kyo Lee.

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Funding

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2016R1C1B1012374).

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None.

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Both the patient and her husband consented to submission of this case report to journal on 14 January 2016.

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Park, SC., Lee, J.K., Kim, CH. et al. Gamma-knife subcaudate tractotomy for treatment-resistant depression and target characteristics: a case report and review. Acta Neurochir 159, 113–120 (2017). https://doi.org/10.1007/s00701-016-3001-3

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  • DOI: https://doi.org/10.1007/s00701-016-3001-3

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