Gamma-knife subcaudate tractotomy for treatment-resistant depression and target characteristics: a case report and review

Abstract

Stereotactic subcaudate tractotomy has previously been suggested to be an effective treatment for depression. This is the first study to report the use of gamma-knife subcaudate tractotomy for treatment-resistant depression. A 49-year-old woman with major depressive disorder had been treated for 30 years, with nine suicide attempts during that time. The right and left target maximum diameter was 11 mm within 50 % isodose lines. The target was located more posteriorly and inferiorly than the subgenual cingulate target typically used for deep-brain stimulation. The maximum radiation dose was 130 Gy. During the 4 months after surgery, the patient improved gradually from 23 to 4 according to the Hamilton Rating Scale for Depression and antidepressant medication was discontinued. Target-sized focal lesions were identified and no edema was seen postoperatively. No aggravation or neurologic deficit occurred during the 2.5 years of follow-up. Gamma-knife subcaudate tractotomy for depression is a minimally invasive technique. Investigations of the effectiveness and safety profile in a larger group are warranted.

Alteration of Interneuron Immunoreactivity and Autophagic Activity in Rat Hippocampus after Single High-Dose Whole-Brain Irradiation

“…However, the mechanism of action in these diseases is not understood, nor have their potential complications been well studied. For example, SRS with high dose photons is currently being explored as a treatment for severe depression [ 1 - 2 ]. For this study, a high dose of WBI was chosen as this is relevant to stereotactic doses of radiation used, for example, to treat trigeminal neuralgia [ 3 ].…”

Concerns About Psychiatric Neurosurgery and How They Can Be Overcome: Recommendations for Responsible Research

“…Very few studies have investigated Gamma Knife for MDD. In a single case study, a patient who had suffered from severe depression for 30 years and made nine suicide attempts experienced a HAM-D reduction of 82.6% four months after Gamma Knife subcaudate tractotomy [111]. In an open label study with three patients, a mean BDI reduction of 65% was observed 2 years after Gamma Knife cingulotomy [33].…”

“…In general, the time course of the success of Gamma Knife treatment in psychiatric indications was similar to that of other functional indications. This speaks against the fact that this procedure has only a placebo effect [111].…”

Three Discipline Collaborative Radiation Therapy (3DCRT) special debate: In the future, at least 20% of NIH funding for radiotherapy research should be allocated to non‐oncologic applications

“…Other indications, in contrast, reveal a divergent acceptance, for example, RT of painful osteoarthrosis (Eastern Europe, 85% vs United States, 5%) . Beyond those widely and regionally accepted indications, there exist a subset of nontraditionally explored indications (movement disorders, rhizotomy outside of the brain, psychiatric disorders, and cardiac arrhythmias) that have been favorably reported in small patient cohorts …”

“…11 Beyond those widely and regionally accepted indications, there exist a subset of nontraditionally explored indications (movement disorders, rhizotomy outside of the brain, psychiatric disorders, and cardiac arrhythmias) that have been favorably reported in small patient cohorts. [12][13][14] Some estimates predict that upward of one-third of all patients undergoing total hip arthroplasty will develop HO, or approximately 50 000-60 000 patients in the United States alone. 11 RT was first used in 1981 in patients at high risk of HO.…”