Amit Azriel1,2, Sarah Farrand3, Maria Di Biase4,5, Andrew Zalesky4, Elaine Lui6, Patricia Desmond6, Andrew Evans7, Mohammed Awad1,2, Samuel Moscovici1,2, Dennis Velakoulis3,4, Richard G Bittar1,2,8,9. 1. Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia. 2. Department of Surgery, The University of Melbourne, Melbourne, Australia. 3. Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia. 4. Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia. 5. Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 6. Department of Radiology and Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia. 7. Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia. 8. Deakin University, Victoria, Australia. 9. Precision Brain Spine and Pain Centre, Kew, Victoria, Australia.
Abstract
BACKGROUND AND IMPORTANCE: Obsessive-compulsive disorder (OCD) is a disabling psychiatric disorder, mainly treated with psychotherapy and pharmacotherapy. Surgical intervention may be appropriate for patients with treatment-refractory OCD. Deep brain stimulation (DBS) is an alternative for previously common ablative surgical procedures. Tractography has been proposed as a method for individualizing DBS treatment and may have the potential to improve efficacy. CLINICAL PRESENTATION: We present a patient with treatment-refractory OCD previously treated with bilateral leucotomies, who underwent DBS surgery with targeting informed by tractography. Preoperative tractography to identify suitable DBS targets was undertaken. Structural images were also utilized for standard stereotactic surgical planning. The anteromedial globus pallidus internus (amGPi) was chosen as the target bilaterally after consideration of white matter projections to frontal cortical regions and neurosurgical approach. Bilateral amGPi DBS surgery was undertaken without adverse events. At 16-mo follow-up, there was a 48.5% reduction in OCD symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale. CONCLUSION: The amGPi can be a successful DBS target for OCD. This is the first known case to report on DBS surgery postleucotomies for OCD and highlights the utility of tractography for surgical planning in OCD.
BACKGROUND AND IMPORTANCE: Obsessive-compulsive disorder (OCD) is a disabling psychiatric disorder, mainly treated with psychotherapy and pharmacotherapy. Surgical intervention may be appropriate for patients with treatment-refractory OCD. Deep brain stimulation (DBS) is an alternative for previously common ablative surgical procedures. Tractography has been proposed as a method for individualizing DBS treatment and may have the potential to improve efficacy. CLINICAL PRESENTATION: We present a patient with treatment-refractory OCD previously treated with bilateral leucotomies, who underwent DBS surgery with targeting informed by tractography. Preoperative tractography to identify suitable DBS targets was undertaken. Structural images were also utilized for standard stereotactic surgical planning. The anteromedial globus pallidus internus (amGPi) was chosen as the target bilaterally after consideration of white matter projections to frontal cortical regions and neurosurgical approach. Bilateral amGPi DBS surgery was undertaken without adverse events. At 16-mo follow-up, there was a 48.5% reduction in OCD symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale. CONCLUSION: The amGPi can be a successful DBS target for OCD. This is the first known case to report on DBS surgery postleucotomies for OCD and highlights the utility of tractography for surgical planning in OCD.
Authors: Kara A Johnson; Gordon Duffley; Thomas Foltynie; Marwan Hariz; Ludvic Zrinzo; Eileen M Joyce; Harith Akram; Domenico Servello; Tommaso F Galbiati; Alberto Bona; Mauro Porta; Fan-Gang Meng; Albert F G Leentjens; Aysegul Gunduz; Wei Hu; Kelly D Foote; Michael S Okun; Christopher R Butson Journal: Biol Psychiatry Cogn Neurosci Neuroimaging Date: 2020-11-24