Tractographic description of major subcortical projection pathways passing the anterior limb of the internal capsule. Corticopetal organization of networks relevant for psychiatric disorders

Coenen, Volker A.; Schläepfer, Thomas E.; Sajonz, Bastian; Döbrössy, Máté; Kaller, Christoph P.; Urbach, Horst; Reisert, Marco

doi:10.1016/j.nicl.2020.102165

Cited by 52 publications

(63 citation statements)

References 110 publications

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“…In other words, the anatomical definition of the medial forebrain bundle does not traverse within the ALIC. This mismatch between the surgical target (sl-MFB) and anatomical literature (mfb) has recently been confirmed by the original authors of the surgical target and they now additionally referred to it with "vtaPP" (for ventral tegmental area projection pathway) 64 . This potentially misleading nomenclature of the surgical sl-MFB target has suggested that results in two previous OCD studies would be conflicting, while anatomically, their results agreed.…”

Section: Discussionmentioning

confidence: 95%

“…To readers, this suggested conflicting results while they were actually confirmatory (based on the location of both tracts within the ALIC). Thus, we welcome the recent steps taken to move away from calling the surgical target sl-MFB toward calling it "vta-PP" 64 . This said, our interpretation of the identified tract differs.…”

Section: Discussionmentioning

confidence: 99%

“…Figure S3 C & results from the basal ganglia pathway atlas, Figure S1-2). Thus, we attribute the tract to afferents of the STN (limbic hyperdirect pathway) as opposed to efferents of the ventral tegmental area implied by the term "vtaPP" 64 .…”

Section: Discussionmentioning

confidence: 99%

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Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Baldermann

Kibleur

et al. 2019

Preprint

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Multiple surgical targets have been proposed for treating obsessive-compulsive disorder (OCD) with deep brain stimulation (DBS). However, different targets may modulate the same neural network responsible for clinical improvement. Here we analyzed data from four cohorts of OCD patients (N = 50) that underwent DBS to the anterior limb of the internal capsule (ALIC), the nucleus accumbens (NAcc) or the subthalamic nucleus (STN). Fiber tracts that were predominantly connected to electrodes in good or poor DBS responders were isolated from a normative structural connectome and assigned a predictive value. Strikingly, the same fiber bundle was related to treatment response when independently analyzing two large training cohorts that targeted either ALIC or STN. This discriminative tract is a subsection of the ALIC and connects frontal regions (such as the dorsal anterior cingulate, dACC, and ventral prefrontal, vlPFC, cortices to the STN). When informing the tract solely based on one cohort (e.g. ALIC), clinical improvements in the other (e.g. STN)could be significantly predicted, and vice versa. Finally, clinical improvements of eight patients from a third center with electrodes in the NAcc and six patients from a fourth center in which electrodes had been implanted in both STN and ALIC were significantly predicted based on this novel tract-based DBS target. Results suggest a functional role of a limbic hyperdirect pathway that projects from dACC and vlPFC to anteriomedial STN. Obsessivecompulsive symptoms seem to be tractable by modulating the specific bundle isolated here.Our results show that connectivity-derived improvement models can inform clinical improvement across DBS targets, surgeons and centers. The identified tract is now threedimensionally defined in stereotactic standard space and will be made openly available.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Baldermann

Kibleur

et al. 2019

Preprint

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“…Among the most commonly performed lesional procedures is the anterior capsulotomy (AC) 13,15 . AC targets the anterior limb of the internal capsule (ALIC), a dense white matter region where fibers from the limbic prefrontal cortex converge towards the ventral striatum and the thalamus 16,17 . Dysfunctional connectivity patterns within this network have been implicated in the pathogenesis of many psychiatric illnesses, including OCD and MDD 17,18 .…”

Section: Introductionmentioning

confidence: 99%

“…AC targets the anterior limb of the internal capsule (ALIC), a dense white matter region where fibers from the limbic prefrontal cortex converge towards the ventral striatum and the thalamus 16,17 . Dysfunctional connectivity patterns within this network have been implicated in the pathogenesis of many psychiatric illnesses, including OCD and MDD 17,18 . Lesioning the ALIC is intended to disrupt the aberrant activity within this network, and mitigate clinical symptoms 19 .…”

Section: Introductionmentioning

confidence: 99%

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

et al. 2020

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Magnetic resonance-guided focused ultrasound (MRgFUS) anterior capsulotomy is a novel treatment option for patients with refractory obsessive compulsive disorder (OCD) or major depressive disorder (MDD). However, there is concern that lesional psychiatric surgery procedures may have adverse effects on cognition. In this study, we examined whether MRgFUS capsulotomy causes cognitive decline in patients with psychiatric illness. Ten patients with refractory OCD (n = 5) or MDD (n = 5) underwent MRgFUS capsulotomy. Cognitive functioning was measured at baseline as well as 6 months and 12 months postoperatively, with a battery of neuropsychological tests assessing domains of executive function, memory, and processing speed. Scores were analyzed at the individual-level, and changes ≥2 standard deviations were considered clinically significant. We also examined whether changes in clinical symptoms were associated with changes in cognitive performance. At baseline intellectual functioning was in the average to high-average range for the group. Following MRgFUS capsulotomy, there were no deteriorations in cognition that reached ≥2 standard deviations at 6 or 12 months. Eight out of ten patients demonstrated a ≥2 standard deviation improvement in at least one cognitive score at 6 or 12 months postoperatively. Improvements in clinical symptoms correlated significantly with self-reported improvements in frontal lobe function (p < 0.05), but not with objective measures of cognitive functioning. To summarize, MRgFUS capsulotomy did not result in cognitive decline in this cohort of patients with refractory OCD or MDD, suggesting that this procedure can be offered to patients with a very low risk of cognitive side effects.

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SPECTRE—A novel dMRI visualization technique for the display of cerebral connectivity

Reisert

Kaller

Reuter

et al. 2021

Human Brain Mapping

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The visualization of diffusion MRI related properties in a comprehensive way is still a challenging problem. We propose a simple visualization technique to give neuroradiologists and neurosurgeons a more direct and personalized view of relevant connectivity patterns estimated from clinically feasible diffusion MRI. The approach, named SPECTRE (Subject sPEcific brain Connectivity display in the Target REgion), is based on tract-weighted imaging, where diffusion MRI streamlines are used to aggregate information from a different MRI contrast. Instead of using native MRI contrasts, we propose to use continuous template information as the underlying contrast for aggregation. In this respect, the SPECTRE approach is complementary to normative approaches where connectivity information is warped from the group level to subject space by anatomical registration. For the purpose of demonstration, we focus the presentation of the SPECTRE approach on the visualization of connectivity patterns in the midbrain regions at the level of subthalamic nucleus due to its importance for deep brain stimulation. The proposed SPECTRE maps are investigated with respect to plausibility, robustness, and test-retest reproducibility. Clear dependencies of reliability measures with respect to the underlying tracking algorithms are observed.

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Tractographic description of major subcortical projection pathways passing the anterior limb of the internal capsule. Corticopetal organization of networks relevant for psychiatric disorders

Cited by 52 publications

References 110 publications

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

SPECTRE—A novel dMRI visualization technique for the display of cerebral connectivity

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