Magnetic Resonance Image-guided Stereotactic Cingulotomy for Intractable Psychiatric Disease

Spangler, Wendy J.; Cosgrove, G. Rees; Ballantine, H. Thomas; Cassem, Edwin H.; Rauch, Scott L.; Andrew, Nierenberg; Price, Bruce H.

doi:10.1227/00006123-199606000-00001

Cited by 98 publications

(47 citation statements)

References 16 publications

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“…Those reports were based on imaging paradigms limited to T1 and T2 sequences obtained without gadolinium. [9][10][11][12] Several notable factors distinguish our case series from previously reported thermal-ablative changes. Our retrospective study was performed on 4 patients who underwent MR imagingguided laser ablation cingulotomy by using a state-of-the-art 980-nm laser.…”

Section: Discussionmentioning

confidence: 65%

“…[9][10][11][12] However, these studies reported only T1-and T2-weighted imaging features and lacked discussion of potential etiologies and evolution of reported signal changes. The multisequential MR imaging characteristics of laser-guided cingulotomy for patients with intractable pain have not been previously characterized, to our knowledge.…”

mentioning

confidence: 99%

“…The purpose of this study was to report the early MR imaging changes associated with cingulotomy by using a 980-nm diode laser. Our descriptions are based on the original work by Spangler et al, 11 who, in 1996, described the postoperative MR imaging characteristics of cingulotomies for the treatment of psychiatric disorders.…”

mentioning

confidence: 99%

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Early MRI Characteristics after MRI-Guided Laser-Assisted Cingulotomy for Intractable Pain Control

Sundararajan

Belani

Danish³

et al. 2015

American Journal of Neuroradiology

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Section: Discussionmentioning

confidence: 65%

mentioning

confidence: 99%

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Early MRI Characteristics after MRI-Guided Laser-Assisted Cingulotomy for Intractable Pain Control

Sundararajan

Belani

Danish³

et al. 2015

American Journal of Neuroradiology

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“…A CGPS scale score of 3, 4, or 5 is consistent with response to treatment. More recently, using the same outcome criteria, Spangler and associates 115 reported a significant improvement (CGPS scale score of 3, 4, or 5) in 60% of patients undergoing cingulotomies for major depression.…”

Section: Historical Human Ablative Limbic System Surgery Datamentioning

confidence: 93%

Biological basis for the surgical treatment of depression

Abosch¹,

Cosgrove

2008

FOC

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An estimated 20% of patients with major depression are refractory to existing therapies. The purpose of this review is to provide a theoretical and neuroscientific framework in which to interpret new work in the field of surgical treatment for depression. This review focuses on existing clinical and imaging data, current disease models, and results of recent case reports and patient series that together may inform the construction of appropriate clinical trials for the surgical treatment of refractory depression.

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“…6,20,29 Approximately 38-61% of patients with TRD who undergo stereotactic anterior cingulotomy or anterior capsulotomy have shown clinical improvement. 11,29,63,64 The main disadvantage to ablative therapies is their irreversibility; however, DBS has the advantage of being both reversible and modulatory. Deep brain stimulation has shown promise in the treatment of TRD in some small series and case reports.…”

mentioning

confidence: 99%

Potential surgical targets for deep brain stimulation in treatment-resistant depression

Hauptman

DeSalles²,

Espinoza³

et al. 2008

FOC

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Object The goal of this study was to evaluate the definition of treatment-resistant depression (TRD), review the literature regarding deep brain stimulation (DBS) for TRD, and identify potential anatomical and functional targets for future widespread clinical application. Methods A comprehensive literature review was performed to determine the current status of DBS for TRD, with an emphasis on the scientific support for various implantation sites. Results The definition of TRD is presented, as is its management scheme. The rationale behind using DBS for depression is reviewed. Five potential targets have been identified in the literature: ventral striatum/nucleus accumbens, subgenual cingulate cortex (area 25), inferior thalamic peduncle, rostral cingulate cortex (area 24a), and lateral habenula. Deep brain stimulation electrodes thus far have been implanted and activated in only the first 3 of these structures in humans. These targets have proven to be safe and effective, albeit in a small number of cases. Conclusions Surgical intervention for TRD in the form of DBS is emerging as a viable treatment alternative to existing modalities. Although the studies reported thus far have small sample sizes, the results appear to be promising. Various surgical targets, such as the subgenual cingulate cortex, inferior thalamic peduncle, and nucleus accumbens, have been shown to be safe and to lead to beneficial effects with various stimulation parameters. Further studies with larger patient groups are required to adequately assess the safety and efficacy of these targets, as well as the optimal stimulation parameters and long-term effects.

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Magnetic Resonance Image-guided Stereotactic Cingulotomy for Intractable Psychiatric Disease

Cited by 98 publications

References 16 publications

Early MRI Characteristics after MRI-Guided Laser-Assisted Cingulotomy for Intractable Pain Control

Early MRI Characteristics after MRI-Guided Laser-Assisted Cingulotomy for Intractable Pain Control

Biological basis for the surgical treatment of depression

Potential surgical targets for deep brain stimulation in treatment-resistant depression

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