Ventral targeted anterior capsulotomy for treatment-resistant depression and obsessive-compulsive disorder: A treatment method with cases.
J Affect Disord
; 350: 887-894, 2024 Apr 01.
Article
en En
| MEDLINE
| ID: mdl-38272366
ABSTRACT
BACKGROUND:
Ablative surgery using bilateral anterior capsulotomy (BAC) is an option for treatment resistant depression (TRD) and obsessive-compulsive disorder (TROCD). The location and extent of the lesion within anterior limb of the internal capsule (ALIC) remains uncertain. Accumulating evidence has suggested that the lesion should be located ventrally while limiting the dorsal extent. Our center is now targeting specific fiber tracts within the lower half of the ALIC.METHOD:
Presurgical diffusion tensor Magnetic Resonance Imaging (MRI) was used to identify individual fibre tracts within the ventral aspect of the ALIC in the last two patients who underwent BAC at our center. One patient had TRD and the other had both TROCD and TRD. Radiofrequency-induced thermal lesions were created in the identified targets with lesion volumes between 20 and 229 mm3 (average 95 mm3).FINDINGS:
Both patients were responders with neither experiencing significant side effects including compromised executive functions.LIMITATIONS:
The generalizability of our findings is limited because the outcome is based on two subjects.CONCLUSION:
This work suggests that BAC can be individually tailored and more limited to the ventral aspect of the ALIC and is effective and safe for TRD and TROCD. Accumulating data also suggests that to be clinically effective the length of the capsulotomy should be about 10mm. BAC's use may increase with the growing utilization and mastery of magnetic resonance guided focused ultrasound.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Trastorno Depresivo Resistente al Tratamiento
/
Trastorno Obsesivo Compulsivo
Tipo de estudio:
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
J Affect Disord
/
J. affect. disord
/
Journal of affective disorders
Año:
2024
Tipo del documento:
Article