Wang Fengting, Liu Wei, Paerhati Halimureti, Lin Zhengyu, Ye Kuanghao, Dai Lulin, Wang Tao, Lan Zhaohui, Li Dianyou, Lai Yijie, Sun Bomin, Zhan Shikun
Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Psychiatry, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China.
BMC Psychiatry. 2025 May 12;25(1):474. doi: 10.1186/s12888-025-06890-5.
Bilateral anterior capsulotomy and deep brain stimulation (DBS) of the nucleus accumbens (NAc) represent investigational treatment options for severe, treatment-refractory anorexia nervosa (AN). However, follow-up studies evaluating postoperative outcomes in these patients remain limited, and the clinical and neuroanatomical characteristics associated with treatment response have yet to be elucidated.
The retrospective study analyzed the preoperative imaging data of AN patients who underwent bilateral anterior capsulotomy or nucleus accumbens (NAc) DBS from 2019 to 2023. Voxel-based morphometry (VBM) was employed to assess structural differences between AN patients and healthy controls (HCs), as well as to identify brain regions associated with postoperative changes in body mass index (BMI).
Nineteen patients were included in the analysis, six of whom received NAc DBS. The mean (standard deviation, SD) BMI of patients significantly increased from 13.4 (2.5) kg/m² preoperatively to 20.7 (5.3) kg/m² postoperatively (t = 5.45, p < 0.001). A significant smaller gray matter volume was observed in widespread regions in AN patients compared to HCs including the cerebellum, the thalamus, the temporal, orbital frontal gyrus and the sensorimotor gyrus in VBM analysis (P < 0.001, cluster size > 30 voxels). After controlling for age, sex, surgical type, and total intracranial volume (TIV), no clusters passed the correction for multiple comparisons in the correlational analysis with BMI changes after surgeries. The volume of the left caudate and the right middle frontal gyrus showed a positive correlation with the percentage of BMI changes, while the volume of the right supplementary motor area, the right parahippocampal gyrus, the right precuneus, and the left cerebellum exhibited a negative correlation in peak-level analysis (P < 0.001).
Both ablative and DBS surgeries demonstrate efficacy in promoting weight restoration in severe AN patients. The structural integrity of specific brain regions may play a role in predicting postoperative BMI recovery. Further studies with a larger number of patients are warranted to better evaluate the outcome of the surgeries and the predictive value of the imaging characteristics.
双侧前扣带回切开术和伏隔核（NAc）深部脑刺激（DBS）是针对严重的、难治性神经性厌食症（AN）的研究性治疗选择。然而，评估这些患者术后结果的随访研究仍然有限，与治疗反应相关的临床和神经解剖学特征尚未阐明。
这项回顾性研究分析了2019年至2023年接受双侧前扣带回切开术或伏隔核（NAc）DBS的AN患者的术前影像数据。采用基于体素的形态学测量（VBM）来评估AN患者与健康对照（HCs）之间的结构差异，以及识别与术后体重指数（BMI）变化相关的脑区。
19名患者纳入分析，其中6名接受了NAc DBS。患者的平均（标准差，SD）BMI从术前的13.4（2.5）kg/m²显著增加到术后的20.7（5.3）kg/m²（t = 5.45，p < 0.001）。在VBM分析中，与HCs相比，AN患者在包括小脑、丘脑、颞叶、眶额回和感觉运动回在内的广泛区域观察到灰质体积显著更小（P < 0.001，簇大小> 30体素）。在控制年龄、性别、手术类型和总颅内体积（TIV）后，在与术后BMI变化的相关性分析中，没有簇通过多重比较校正。在峰值水平分析中，左侧尾状核和右侧额中回的体积与BMI变化百分比呈正相关，而右侧辅助运动区、右侧海马旁回、右侧楔前叶和左侧小脑的体积呈负相关（P < 0.001）。
毁损性手术和DBS手术在促进重度AN患者体重恢复方面均显示出疗效。特定脑区的结构完整性可能在预测术后BMI恢复中起作用。需要更多患者的进一步研究来更好地评估手术结果和影像特征的预测价值。
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