Bilateral Anterior Capsulotomy for Intractable Depression

Hurwitz, Trevor A.; Honey, Christopher R.; Allen, Judith; Gosselin, Caroline; Hewko, Robert; Martzke, Jeff; Bogod, Nicholas M.; Taylor, Patricia A.

doi:10.1176/appi.neuropsych.11080189

Cited by 32 publications

(39 citation statements)

References 25 publications

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“…Capsulotomy involves a lesion in the anterior limb of the internal capsule, hence severing fronto-striatal and limbic projections. A recent study of 8 patients with treatmentrefractory depression found that bilateral anterior capsulotomy resulted in complete or partial remission in 4 patients at the 2-3 year follow-up [84].…”

Section: Major Depression and Obsessive-compulsive Disordermentioning

confidence: 98%

Intracranial Applications of Magnetic Resonance-guided Focused Ultrasound

et al. 2014

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The ability to focus acoustic energy through the intact skull on to targets millimeters in size represents an important milestone in the development of neurotherapeutics. Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel, noninvasive method, which-under real-time imaging and thermographic guidance-can be used to generate focal intracranial thermal ablative lesions and disrupt the blood-brain barrier. An established treatment for bone metastases, uterine fibroids, and breast lesions, MRgFUS has now been proposed as an alternative to open neurosurgical procedures for a wide variety of indications. Studies investigating intracranial MRgFUS range from small animal preclinical experiments to large, late-phase randomized trials that span the clinical spectrum from movement disorders, to vascular, oncologic, and psychiatric applications. We review the principles of MRgFUS and its use for brain-based disorders, and outline future directions for this promising technology.

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Section: Major Depression and Obsessive-compulsive Disordermentioning

confidence: 98%

Intracranial Applications of Magnetic Resonance-guided Focused Ultrasound

et al. 2014

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“…Hurwitz et al [44] of the Vancouver Limbic Surgery Group (VLSG) reported 8 patients with MDD who underwent bilateral anterior capsulotomy using radiofrequency lesions. MR imaging conducted postoperatively found the ellipsoidal lesion volumes to be, on average, 4.8 × 4.4 × 14.2 mm, and 5.8 × 5.1 × 14.8 mm in diameter for the left and right hemispheres, respectively [44].…”

Section: Anterior Capsulotomymentioning

confidence: 99%

“…MR imaging conducted postoperatively found the ellipsoidal lesion volumes to be, on average, 4.8 × 4.4 × 14.2 mm, and 5.8 × 5.1 × 14.8 mm in diameter for the left and right hemispheres, respectively [44]. The procedure was well-tolerated by 7 of the 8 patients, with 1 patient developing akinetic mutism followed by dementia with parkinsonism, ultimately dying 2 years postoperatively due to renal failure [44]. Autopsy revealed extensive arteriolosclerosis secondary to a 40-year history of hypertension, which was deemed responsible for his vascular dementia [44].…”

Section: Anterior Capsulotomymentioning

confidence: 99%

“…The procedure was well-tolerated by 7 of the 8 patients, with 1 patient developing akinetic mutism followed by dementia with parkinsonism, ultimately dying 2 years postoperatively due to renal failure [44]. Autopsy revealed extensive arteriolosclerosis secondary to a 40-year history of hypertension, which was deemed responsible for his vascular dementia [44]. Overall, 4 out of 8 patients (50%) were classified as responders (greater than 50% reduction in pre-operative BDI score) between 24 and 36 months postoperatively [44].…”

Section: Anterior Capsulotomymentioning

confidence: 99%

“…Autopsy revealed extensive arteriolosclerosis secondary to a 40-year history of hypertension, which was deemed responsible for his vascular dementia [44]. Overall, 4 out of 8 patients (50%) were classified as responders (greater than 50% reduction in pre-operative BDI score) between 24 and 36 months postoperatively [44]. Transient AEs included postoperative confusion (2 patients, 25.0%), fatigue (2 patients, 25.0%), subjective emotional blunting (2 patients, 25.0%), and difficulty formulating higher-order thoughts and ideas (1 patient, 12.5%) [44].…”

Section: Anterior Capsulotomymentioning

confidence: 99%

See 2 more Smart Citations

The History and Future of Ablative Neurosurgery for Major Depressive Disorder

Volpini¹,

Giacobbe

Cosgrove

et al. 2017

Stereotact Funct Neurosurg

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Background: There is an urgent need to develop safe and effective treatments for patients with treatment-resistant depression (TRD). Several neurosurgical procedures have been developed to treat the dysfunctional brain circuits implicated in major depression. Objectives: This review describes the most common ablative procedures used to treat major depressive disorder: anterior cingulotomy, subcaudate tractotomy, limbic leucotomy, and anterior capsulotomy. The efficacy and safety of each are discussed and compared with other current and emerging modalities, including deep brain stimulation (DBS) and MR-guided focused ultrasound (MRgFUS). Methods: The PubMed and MEDLINE electronic databases were used in this study, through July 2016. Keywords, including “treatment resistant depression,” and “ablative neurosurgery,” etc. were used to generate reference hits. Results: Approximately a third to half of patients who underwent ablative procedures achieved a treatment response and/or remission. The efficacy and safety profiles corresponding to both ablative procedures and DBS were very similar. Conclusions: The longitudinal experience with ablative procedures shows that there remains an important role for accurate, discrete lesions in disrupting affective circuitry in the treatment of TRD. New modalities, such as MRgFUS, have the potential to further improve the accuracy of ablative procedures, while enhancing safety by obviating the need for open brain surgery.

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Surgical Treatments for Anorexia Nervosa

Sun

Liu

et al. 2014

Neurosurgical Treatments for Psychiatric Disorders

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Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity and mortality. An estimated 21 % of patients experience a chronic course despite treatment with the best available medications and behavioral therapies. Existing data suggest that lesioning and deep brain stimulation can benefit a large proportion (ranging from 60 to 80 %) of patients with medically intractable AN. Long-term serious adverse events are very infrequent. Functional neuroimaging studies have increased our understanding of the mechanisms of disease development and therapeutic action. At our institution, we grade AN on a four-point scale based on patient clinical characteristics and our surgical experience over the past 8 years. This scale is particularly useful for guiding the selection of surgical procedures. Such treatment options include deep brain stimulation or lesioning of the nucleus accumbens, anterior capsulotomy, and anterior cingulotomy. Data suggest that surgical treatment is a viable option for intractable AN, and can alleviate suffering and improve the quality of life of patients with these disabling disorders.

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Bilateral Anterior Capsulotomy for Intractable Depression

Cited by 32 publications

References 25 publications

Intracranial Applications of Magnetic Resonance-guided Focused Ultrasound

Intracranial Applications of Magnetic Resonance-guided Focused Ultrasound

The History and Future of Ablative Neurosurgery for Major Depressive Disorder

Surgical Treatments for Anorexia Nervosa

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