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Tractographic analysis of historical lesion surgery for depression. | LitMetric

AI Article Synopsis

  • Various surgical brain ablation procedures were developed in the 20th century to treat refractory depression, targeting areas like the anterior cingulum, anterior limb of the internal capsule, and subcaudate white matter, with the latter two showing better long-term symptom remission.
  • The clinical improvements from these procedures may be linked to their effects on unspecified brain networks that regulate emotions, which modern imaging techniques like diffusion tensor imaging (DTI) can help analyze.
  • A study involving 53 healthy individuals identified shared connectivities between the surgical targets, revealing that these connectivities connect to key areas in the frontal lobe and interact with the brain's reward system, suggesting a potential mechanism of how these surgeries boost mood.

Article Abstract

Various surgical brain ablation procedures for the treatment of refractory depression were developed in the twentieth century. Most notably, key target sites were (i) the anterior cingulum, (ii) the anterior limb of the internal capsule, and (iii) the subcaudate white matter, which were regarded as effective targets. Long-term symptom remissions were better following lesions of the anterior internal capsule and subcaudate white matter than of the cingulum. It is possible that the observed clinical improvements of these various surgical procedures may reflect shared influences on presently unspecified brain affect-regulating networks. Such possibilities can now be analyzed using modern brain connectivity procedures such as diffusion tensor imaging (DTI) tractography. We determined whether the shared connectivities of the above lesion sites in healthy volunteers might explain the therapeutic effects of the various surgical approaches. Accordingly, modestly sized historical lesions, especially of the anatomical overlap areas, were 'implanted' in brain-MRI scans of 53 healthy subjects. These were entered as seed regions for probabilistic DTI connectivity reconstructions. We analyzed for the shared connectivities of bilateral anterior capsulotomy, anterior cingulotomy, subcaudate tractotomy, and stereotactic limbic leucotomy (a combination of the last two lesion sites). Shared connectivities between the four surgical approaches mapped onto the most mediobasal aspects of bilateral frontal lobe fibers, including the forceps minor and the anterior thalamic radiations that contacted subgenual cingulate regions. Anatomically, convergence of these shared connectivities may derive from the superolateral branch of the medial forebrain bundle (MFB), a structure that connects these frontal areas to the origin of the mesolimbic dopaminergic 'reward' system in the midbrain ventral tegmental area. Thus, all four surgical anti-depressant approaches may be promoting positive affect by converging influences onto the MFB.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055575PMC
http://dx.doi.org/10.1038/npp.2010.132DOI Listing

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