Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
Current affiliation: Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Neurosurgery. 2024 Oct 1;95(4):941-948. doi: 10.1227/neu.0000000000002942. Epub 2024 Apr 19.
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.
治疗抵抗性抑郁症是导致残疾的主要原因。我们中心的神经外科治疗抵抗性抑郁症的试验涉及为植入个性化闭环神经调节装置治疗难治性抑郁症进行分阶段的评估。评估的第一阶段（“阶段 1”）包括双侧将 10 个立体脑电图（SEEG）电极植入 5 个解剖定义明确的脑区，涉及专门的术前成像和规划评估以及基于框架的操作方案。
当规划 5 个解剖区域中的 3 个的立体定向靶点时，我们依赖扩散张量成像。我们概述了针对杏仁核、腹侧纹状体和腹侧囊以及扣带回下前侧的目标的基本原理和纤维束。我们还概述了基于框架的立体定向考虑因素，用于植入 SEEG 电极。
在这项正在进行的研究中，我们的方法允许我们在 3 名试验参与者中的 3 名安全地靶向所有 5 个脑区，并且在使用轨迹追踪术靶向的 3 个区域中的每个区域都有足够的纤维束接触。此外，我们最终使用我们的 1 期评估的轨迹追踪数据来指导 2 期（植入反应性神经调节装置）的靶向。完成我们的数据集后，我们将确定所有电极激活的组织体积与解剖学和轨迹追踪术定义的感兴趣区域之间的重叠。
我们为 SEEG 电极植入制定的方案包括轨迹追踪术和基于框架的立体定向术。
