Stereoelectroencephalography Electrode Implantation for Inpatient Workup of Treatment-Resistant Depression.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
received:
25
07
2023
accepted:
06
02
2024
medline:
17
9
2024
pubmed:
17
9
2024
entrez:
16
9
2024
Statut:
ppublish
Résumé
Treatment-resistant depression is a leading cause of disability. Our center's trial for neurosurgical intervention for treatment-resistant depression involves a staged workup for implantation of a personalized, closed-loop neuromodulation device for refractory depression. The first stage ("stage 1") of workup involves implantation of 10 stereoelectroencephalography (SEEG) electrodes bilaterally into 5 anatomically defined brain regions and involves a specialized preoperative imaging and planning workup and a frame-based operating protocol. We rely on diffusion tractography when planning stereotactic targets for 3 of 5 anatomic areas. We outline the rationale and fiber tracts that we focus on for targeting amygdala, ventral striatum and ventral capsule, and subgenual cingulate. We also outline frame-based stereotactic considerations for implantation of SEEG electrodes. Our method has allowed us to safely target all 5 brain areas in 3 of 3 trial participants in this ongoing study, with adequate fiber bundle contact in each of the 3 areas targeted using tractography. Furthermore, we ultimately used tractography data from our stage 1 workup to guide targeting near relevant fiber bundles for stage 2 (implantation of a responsive neuromodulation device). On completion of our data set, we will determine the overlap between volume of tissue activated for all electrodes and areas of interest defined by anatomy and tractography. Our protocol outlined for SEEG electrode implantation incorporates tractography and frame-based stereotaxy.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Treatment-resistant depression is a leading cause of disability. Our center's trial for neurosurgical intervention for treatment-resistant depression involves a staged workup for implantation of a personalized, closed-loop neuromodulation device for refractory depression. The first stage ("stage 1") of workup involves implantation of 10 stereoelectroencephalography (SEEG) electrodes bilaterally into 5 anatomically defined brain regions and involves a specialized preoperative imaging and planning workup and a frame-based operating protocol.
METHODS
METHODS
We rely on diffusion tractography when planning stereotactic targets for 3 of 5 anatomic areas. We outline the rationale and fiber tracts that we focus on for targeting amygdala, ventral striatum and ventral capsule, and subgenual cingulate. We also outline frame-based stereotactic considerations for implantation of SEEG electrodes.
EXPECTED OUTCOMES
OBJECTIVE
Our method has allowed us to safely target all 5 brain areas in 3 of 3 trial participants in this ongoing study, with adequate fiber bundle contact in each of the 3 areas targeted using tractography. Furthermore, we ultimately used tractography data from our stage 1 workup to guide targeting near relevant fiber bundles for stage 2 (implantation of a responsive neuromodulation device). On completion of our data set, we will determine the overlap between volume of tissue activated for all electrodes and areas of interest defined by anatomy and tractography.
DISCUSSION
CONCLUSIONS
Our protocol outlined for SEEG electrode implantation incorporates tractography and frame-based stereotaxy.
Identifiants
pubmed: 39283114
doi: 10.1227/neu.0000000000002942
pii: 00006123-202410000-00025
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
941-948Subventions
Organisme : NIH HHS
ID : K23NS110962
Pays : United States
Organisme : NIH HHS
ID : U01NS098971, R01MH114860, R01MH111444, R01DC015504, R01DC01237, UH3 NS109556, UH3NS115631 and R01 NS105675
Pays : United States
Organisme : NIH HHS
ID : P01AG019724, R01 HL142051-01, R01AG059794, R01DK117953, UH3 NS109556-01 and R01AG060477-01A1
Pays : United States
Organisme : NIH HHS
ID : U24 DA041123
Pays : United States
Organisme : Dolby Family Ventures
ID : Ray and Dagmar Dolby Family Fund through the Department of Psychiatry at the University of California, San Francisco
Informations de copyright
Copyright © Congress of Neurological Surgeons 2024. All rights reserved.
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