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Cited by 160Neurological disorders and treatmentsObsessive-Compulsive Spectrum DisordersTreatment of Major Depression

Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting: Clinical article

Hamani, Clement, Mayberg, Helen, Snyder, Brian, Giacobbe, Peter, Kennedy, Sidney, Lozano, Andres M.·2009·Journal of neurosurgery
DOI 10.3171/2008.10.jns08763
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Abstract

OBJECT: Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG), including Brodmann area 25, is currently being investigated for the treatment of major depressive disorder (MDD). As a potential emerging therapy, optimal target selection within the SCG has still to be determined. The authors compared the location of the electrode contacts in responders and nonresponders to DBS of the SCG and correlated the results with clinical outcome to help in identifying the optimal target within the region. Based on the location of the active contacts used for long-term stimulation in responders, the authors suggest a standardized method of targeting the SCG in patients with MDD. METHODS: Postoperative MR imaging studies of 20 patients with MDD treated with DBS of the SCG were analyzed. The authors assessed the location of the active contacts relative to the midcommissural point and in relation to anatomical landmarks within the medial aspect of the frontal lobe. For this, a grid with 2 main lines was designed, with 1 line in the anterior-posterior and 1 line in the dorsal-ventral axis. Each of these lines was divided into 100 units, and data were converted into percentages. The anterior-posterior line extended from the anterior commissure (AC) to the projection of the anterior aspect of the corpus callosum (CCa). The dorsal-ventral line extended from the inferior portion of the CC (CCi) to the most ventral aspect of the frontal lobe (abbreviated "Fr" for the formula). RESULTS: Because the surgical technique did not vary across patients, differences in stereotactic coordinates between responders and nonresponders did not exceed 1.5 mm in any axis (x, y, or z). In patients who responded to the procedure, contacts used for long-term stimulation were in close approximation within the SCG. In the anterior-posterior line, these contacts were located within a 73.2 +/- 7.7 percentile distance from the AC (with the AC center being 0% and the line crossing the CCa being 100%). In the dorsal-ventral line, active contacts in responders were located within a 26.2 +/- 13.8 percentile distance from the CCi (with the CCi edge being 0% and the Fr inferior limit being 100%). In the medial-lateral plane, most electrode tips were in the transition between the gray and white matter of SCG. CONCLUSIONS: Active contacts in patients who responded to DBS were relatively clustered within the SCG. Because of the anatomical variability in the size and shape of the SCG, the authors developed a method to standardize the targeting of this region.

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Authors
Hamani, C., Mayberg, H., Snyder, B., Giacobbe, P., Kennedy, S., & Lozano, A. M.
Affiliations
  • Toronto Western Hospital (CA)
  • Emory University (US)
  • University Health Network (CA)
  • Division of Neurosurgery, Toronto Western Hospital, and
ORCID
Venue
Journal of neurosurgery
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Published
2009-12
Volume
111
Issue
6
Pages
1209-1215
ISSN
  • 0022-3085 (ISSN-L)
  • 1933-0693
DOI
10.3171/2008.10.jns08763
OpenAlex
W1977723029
Cited by
160
References
16
Citations by year
2026: 1 · 2025: 4 · 2024: 6 · 2023: 6 · 2022: 5 · 2021: 10 · 2020: 11 · 2019: 7 · 2018: 5 · 2017: 10 · 2016: 12 · 2015: 6 · 2014: 11 · 2013: 15 · 2012: 18
FWCI
10.67
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of neurosurgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
deep brain stimulation, major depressive disorder, DBS target selection, stereotactic targeting, anterior commissure, corpus callosum, treatment response, anatomical landmarks, postoperative MRI, medial frontal lobe
MeSH terms
Major Depressive Disorder, Depressive Disorder, Major, Electrodes, Implanted, Follow-Up Studies, Gyrus Cinguli, Humans, Magnetic Resonance Imaging, Psychiatric Status Rating Scales, Stereotaxic Techniques, Treatment Outcome, Practice Guidelines as Topic, Neurosurgical Procedures, Deep Brain Stimulation

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