Deep Brain Stimulation of the Lateral Habenular Complex in Treatment-Resistant Depression: Traps and Pitfalls of Trajectory Choice
BACKGROUND:Deep brain stimulation (DBS) has recently been discussed as a promising treatment option for severe cases of major depression. Experimental data have suggested that the lateral habenular complex (LHb-c) is a central region of depression-related neuronal circuits. Because of its location c...
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| Veröffentlicht in: | Neurosurgery 2013-06, Vol.72 OPERATIVE NEUROSURGERY 2 (2 Suppl Operative), p.ons184-ons193 |
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| container_volume | 72 OPERATIVE NEUROSURGERY 2 |
| creator | Schneider, Till M Beynon, Christopher Sartorius, Alexander Unterberg, Andreas W Kiening, Karl L |
| description | BACKGROUND:Deep brain stimulation (DBS) has recently been discussed as a promising treatment option for severe cases of major depression. Experimental data have suggested that the lateral habenular complex (LHb-c) is a central region of depression-related neuronal circuits. Because of its location close to the midline, stereotactic targeting of the LHb-c presents surgeons with distinct challenges.
OBJECTIVE:To define the obstacles of DBS surgery for stimulation of the LHb-c and thus to establish safe trajectories.
METHODS:Stereotactic magnetic resonance imaging data sets of 54 hemispheres originating from 27 DBS patients were taken for analysis on a stereotactic planning workstation. After alignment of images according to the anterior commissure--posterior commissure definition, analyses focused on vessels and enlarged ventricles interfering with trajectories.
RESULTS:As major trajectory obstacles, enlarged ventricles and an interfering superior thalamic vein were found. A standard frontal trajectory (angle > 40° relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was safely applicable in 48% of patients, whereas a steeper frontal trajectory (angle |
| doi_str_mv | 10.1227/NEU.0b013e318277a5aa |
| format | Article |
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OBJECTIVE:To define the obstacles of DBS surgery for stimulation of the LHb-c and thus to establish safe trajectories.
METHODS:Stereotactic magnetic resonance imaging data sets of 54 hemispheres originating from 27 DBS patients were taken for analysis on a stereotactic planning workstation. After alignment of images according to the anterior commissure--posterior commissure definition, analyses focused on vessels and enlarged ventricles interfering with trajectories.
RESULTS:As major trajectory obstacles, enlarged ventricles and an interfering superior thalamic vein were found. A standard frontal trajectory (angle > 40° relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was safely applicable in 48% of patients, whereas a steeper frontal trajectory (angle <40 relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was possible in 96%. Taken together, safe bilateral targeting of the LHb-c was possible in 98% of all patients.
CONCLUSION:Targeting LHb-c is a feasible and safe technique in the majority of patients undergoing surgery for DBS. However, meticulous individual planning to avoid interference with ventricles and thalamus-related veins is mandatory because an alternative steep frontal entry point has to be considered in about half of the patients.
ABBREVIATIONS:AC-PC, anterior commissure--posterior commissureDBS, deep brain stimulationLHb-c, lateral habenular complexMHb, medial habenulaRM, Riechert-MundingerSTV, superior thalamic veinZD, Zamorano-Duchovny</description><identifier>ISSN: 0148-396X</identifier><identifier>ISSN: 2332-4252</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/NEU.0b013e318277a5aa</identifier><identifier>PMID: 23147781</identifier><language>eng</language><publisher>United States: Copyright by the Congress of Neurological Surgeons</publisher><subject>Adolescent ; Aged ; Aged, 80 and over ; Child ; Deep Brain Stimulation - methods ; Depressive Disorder, Treatment-Resistant - therapy ; Electrodes, Implanted ; Female ; Habenula ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Stereotaxic Techniques</subject><ispartof>Neurosurgery, 2013-06, Vol.72 OPERATIVE NEUROSURGERY 2 (2 Suppl Operative), p.ons184-ons193</ispartof><rights>Copyright © by the Congress of Neurological Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3010-785093b97aa6d019a3cf112a2e9587d089e4c472dad9d69ba7b4e47dbc5d128f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23147781$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schneider, Till M</creatorcontrib><creatorcontrib>Beynon, Christopher</creatorcontrib><creatorcontrib>Sartorius, Alexander</creatorcontrib><creatorcontrib>Unterberg, Andreas W</creatorcontrib><creatorcontrib>Kiening, Karl L</creatorcontrib><title>Deep Brain Stimulation of the Lateral Habenular Complex in Treatment-Resistant Depression: Traps and Pitfalls of Trajectory Choice</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>BACKGROUND:Deep brain stimulation (DBS) has recently been discussed as a promising treatment option for severe cases of major depression. Experimental data have suggested that the lateral habenular complex (LHb-c) is a central region of depression-related neuronal circuits. Because of its location close to the midline, stereotactic targeting of the LHb-c presents surgeons with distinct challenges.
OBJECTIVE:To define the obstacles of DBS surgery for stimulation of the LHb-c and thus to establish safe trajectories.
METHODS:Stereotactic magnetic resonance imaging data sets of 54 hemispheres originating from 27 DBS patients were taken for analysis on a stereotactic planning workstation. After alignment of images according to the anterior commissure--posterior commissure definition, analyses focused on vessels and enlarged ventricles interfering with trajectories.
RESULTS:As major trajectory obstacles, enlarged ventricles and an interfering superior thalamic vein were found. A standard frontal trajectory (angle > 40° relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was safely applicable in 48% of patients, whereas a steeper frontal trajectory (angle <40 relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was possible in 96%. Taken together, safe bilateral targeting of the LHb-c was possible in 98% of all patients.
CONCLUSION:Targeting LHb-c is a feasible and safe technique in the majority of patients undergoing surgery for DBS. However, meticulous individual planning to avoid interference with ventricles and thalamus-related veins is mandatory because an alternative steep frontal entry point has to be considered in about half of the patients.
ABBREVIATIONS:AC-PC, anterior commissure--posterior commissureDBS, deep brain stimulationLHb-c, lateral habenular complexMHb, medial habenulaRM, Riechert-MundingerSTV, superior thalamic veinZD, Zamorano-Duchovny</description><subject>Adolescent</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Child</subject><subject>Deep Brain Stimulation - methods</subject><subject>Depressive Disorder, Treatment-Resistant - therapy</subject><subject>Electrodes, Implanted</subject><subject>Female</subject><subject>Habenula</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Stereotaxic Techniques</subject><issn>0148-396X</issn><issn>2332-4252</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkM1u1TAQhS0EopeWN0DISzYp45_ECTu4LRTpqkW0ldhZk3iim-L8YDsq3fLkuGoBCW8szTnzjfQx9krAsZDSvD0_vT6GFoQiJWppDJaIT9hGlFIXGjQ8ZRsQui5UU307YC9ivAEQlTb1c3YgldDG1GLDfp0QLfxDwGHil2kYV49pmCc-9zztie8wUUDPz7ClKWeBb-dx8fST5_5VIEwjTan4SnGICafET2gJFGNGvMs5LpHj5PiXIfXofbzH5ukNdWkOd3y7n4eOjtizHEZ6-fgfsuuPp1fbs2J38enz9v2u6BQIKExdQqPaxiBWDkSDquuFkCipKWvjoG5Id9pIh65xVdOiaTVp49qudELWvTpkbx64S5h_rBSTHYfYkfc40bxGK1RZalNmabmqH6pdmGMM1NslDCOGOyvA3tu32b79335ee_14YW1Hcn-X_uj-x72dfRYbv_v1loLdE_q0t5BfJaQqZOZCBSCLPBGgfgM3lJKw</recordid><startdate>201306</startdate><enddate>201306</enddate><creator>Schneider, Till M</creator><creator>Beynon, Christopher</creator><creator>Sartorius, Alexander</creator><creator>Unterberg, Andreas W</creator><creator>Kiening, Karl L</creator><general>Copyright by the Congress of Neurological Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201306</creationdate><title>Deep Brain Stimulation of the Lateral Habenular Complex in Treatment-Resistant Depression: Traps and Pitfalls of Trajectory Choice</title><author>Schneider, Till M ; Beynon, Christopher ; Sartorius, Alexander ; Unterberg, Andreas W ; Kiening, Karl L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3010-785093b97aa6d019a3cf112a2e9587d089e4c472dad9d69ba7b4e47dbc5d128f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Child</topic><topic>Deep Brain Stimulation - methods</topic><topic>Depressive Disorder, Treatment-Resistant - therapy</topic><topic>Electrodes, Implanted</topic><topic>Female</topic><topic>Habenula</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Stereotaxic Techniques</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schneider, Till M</creatorcontrib><creatorcontrib>Beynon, Christopher</creatorcontrib><creatorcontrib>Sartorius, Alexander</creatorcontrib><creatorcontrib>Unterberg, Andreas W</creatorcontrib><creatorcontrib>Kiening, Karl L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schneider, Till M</au><au>Beynon, Christopher</au><au>Sartorius, Alexander</au><au>Unterberg, Andreas W</au><au>Kiening, Karl L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Deep Brain Stimulation of the Lateral Habenular Complex in Treatment-Resistant Depression: Traps and Pitfalls of Trajectory Choice</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2013-06</date><risdate>2013</risdate><volume>72 OPERATIVE NEUROSURGERY 2</volume><issue>2 Suppl Operative</issue><spage>ons184</spage><epage>ons193</epage><pages>ons184-ons193</pages><issn>0148-396X</issn><issn>2332-4252</issn><eissn>1524-4040</eissn><abstract>BACKGROUND:Deep brain stimulation (DBS) has recently been discussed as a promising treatment option for severe cases of major depression. Experimental data have suggested that the lateral habenular complex (LHb-c) is a central region of depression-related neuronal circuits. Because of its location close to the midline, stereotactic targeting of the LHb-c presents surgeons with distinct challenges.
OBJECTIVE:To define the obstacles of DBS surgery for stimulation of the LHb-c and thus to establish safe trajectories.
METHODS:Stereotactic magnetic resonance imaging data sets of 54 hemispheres originating from 27 DBS patients were taken for analysis on a stereotactic planning workstation. After alignment of images according to the anterior commissure--posterior commissure definition, analyses focused on vessels and enlarged ventricles interfering with trajectories.
RESULTS:As major trajectory obstacles, enlarged ventricles and an interfering superior thalamic vein were found. A standard frontal trajectory (angle > 40° relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was safely applicable in 48% of patients, whereas a steeper frontal trajectory (angle <40 relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was possible in 96%. Taken together, safe bilateral targeting of the LHb-c was possible in 98% of all patients.
CONCLUSION:Targeting LHb-c is a feasible and safe technique in the majority of patients undergoing surgery for DBS. However, meticulous individual planning to avoid interference with ventricles and thalamus-related veins is mandatory because an alternative steep frontal entry point has to be considered in about half of the patients.
ABBREVIATIONS:AC-PC, anterior commissure--posterior commissureDBS, deep brain stimulationLHb-c, lateral habenular complexMHb, medial habenulaRM, Riechert-MundingerSTV, superior thalamic veinZD, Zamorano-Duchovny</abstract><cop>United States</cop><pub>Copyright by the Congress of Neurological Surgeons</pub><pmid>23147781</pmid><doi>10.1227/NEU.0b013e318277a5aa</doi></addata></record> |
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| ispartof | Neurosurgery, 2013-06, Vol.72 OPERATIVE NEUROSURGERY 2 (2 Suppl Operative), p.ons184-ons193 |
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| source | MEDLINE; Journals@Ovid Ovid Autoload |
| subjects | Adolescent Aged Aged, 80 and over Child Deep Brain Stimulation - methods Depressive Disorder, Treatment-Resistant - therapy Electrodes, Implanted Female Habenula Humans Magnetic Resonance Imaging Male Middle Aged Stereotaxic Techniques |
| title | Deep Brain Stimulation of the Lateral Habenular Complex in Treatment-Resistant Depression: Traps and Pitfalls of Trajectory Choice |
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