Psychosurgery: Stereotactic Subcaudate Tractotomy

Bridges, P. K.; Bartlett, John R.; Hale, Anthony S.; Poynton, Amanda; Malizia, Andrea L.; Hodgkiss, Andrew

doi:10.1192/bjp.165.5.599

Cited by 122 publications

(68 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However the relationship between affective disorders and orbitofrontal dysfunction remains unclear. The surgical procedure of subcaudate tractotomy, resulting in disconnection of the orbitofrontal cortex, is reported as effective in the treatment of severe resistant depression (Bridges et al 1994). Curiously, functional abnormalities are only rarely reported in this region in imaging studies of depression (e.g.…”

Section: Introductionmentioning

confidence: 99%

The interaction between mood and cognitive function studied with PET

1997

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

The interaction between mood and cognitive function studied with PET

1997

View full text Add to dashboard Cite

show abstract

“…At least 1300 cases of stereotactic subcaudate tractotomy (SST) were reported between 1961 and 1994 at the Geoffrey Knight Unit alone [4]. Popularity waned, and SST and limbic leucotomy have been discontinued in the UK [5].…”

Section: Discussionmentioning

confidence: 99%

“…The single pair of linear gliottic signal abnormalities that we see were lateral to the cingulate gyri and extended beneath the caudate (Figure 2b). This finding has been described for subcaudate tractotomy [3], which was also popular in the UK at the relevant time for the treatment of a number of indications, including intractable depression [4]. With an interest in mapping the white matter tracts in the area of the lesion, the patient was offered an MR diffusion tensor imaging (DTI) study, under institutional review board approval, which he accepted.…”

mentioning

confidence: 99%

MR imaging of psychosurgery: rostral atrophy following stereotacic subcaudate tractotomy

Cauley¹,

Waheed

Salmela³

et al. 2010

BJR

View full text Add to dashboard Cite

ABSTRACT. There are few reports of MR imaging findings following psychosurgery. Here, we report the findings of 3T MR imaging of the sequelae of stereotactic subcaudate tractotomy (SST). Rostral atrophy is noted on conventional imaging. Diffusion tensor (DT) tractography demonstrated no communicating white matter tracts between the inferior frontal lobes, which appeared normally as thick fibre bundles in age-matched controls. DT tractography provides a unique tool for the evaluation of sequelae of ablative psychosurgical procedures.

show abstract

“…ACT was probably the least effective of the surgical procedures. (iii) Subcaudate tractotomy (SCT) was introduced by Knight in the 1950s (Knight, 1969;Bridges et al, 1994). Initially, radioactive seeds were placed in the target region posterior to the orbito-frontal cortex.…”

Section: Introductionmentioning

confidence: 99%

Tractographic Analysis of Historical Lesion Surgery for Depression

Schoene-Bake

Parpaley

Weber

et al. 2010

Neuropsychopharmacol

View full text Add to dashboard Cite

Various surgical brain ablation procedures for the treatment of refractory depression were developed in the twentieth century. Most notably, key target sites were (i) the anterior cingulum, (ii) the anterior limb of the internal capsule, and (iii) the subcaudate white matter, which were regarded as effective targets. Long-term symptom remissions were better following lesions of the anterior internal capsule and subcaudate white matter than of the cingulum. It is possible that the observed clinical improvements of these various surgical procedures may reflect shared influences on presently unspecified brain affect-regulating networks. Such possibilities can now be analyzed using modern brain connectivity procedures such as diffusion tensor imaging (DTI) tractography. We determined whether the shared connectivities of the above lesion sites in healthy volunteers might explain the therapeutic effects of the various surgical approaches. Accordingly, modestly sized historical lesions, especially of the anatomical overlap areas, were 'implanted' in brain-MRI scans of 53 healthy subjects. These were entered as seed regions for probabilistic DTI connectivity reconstructions. We analyzed for the shared connectivities of bilateral anterior capsulotomy, anterior cingulotomy, subcaudate tractotomy, and stereotactic limbic leucotomy (a combination of the last two lesion sites). Shared connectivities between the four surgical approaches mapped onto the most mediobasal aspects of bilateral frontal lobe fibers, including the forceps minor and the anterior thalamic radiations that contacted subgenual cingulate regions. Anatomically, convergence of these shared connectivities may derive from the superolateral branch of the medial forebrain bundle (MFB), a structure that connects these frontal areas to the origin of the mesolimbic dopaminergic 'reward' system in the midbrain ventral tegmental area. Thus, all four surgical anti-depressant approaches may be promoting positive affect by converging influences onto the MFB.

show abstract

Psychosurgery: Stereotactic Subcaudate Tractotomy

Abstract: As a treatment of last resort, no controlled trial against a comparable treatment is possible. It appears reasonable to offer SST to patients with suicidal and deluded depression or with frequently swinging moods, not responding to other treatments.

Cited by 122 publications

References 46 publications

The interaction between mood and cognitive function studied with PET

The interaction between mood and cognitive function studied with PET

MR imaging of psychosurgery: rostral atrophy following stereotacic subcaudate tractotomy

Tractographic Analysis of Historical Lesion Surgery for Depression

Contact Info

Product

Resources

About