Prospective assessment of stereotactic ablative surgery for intractable major depression.
BACKGROUND
Despite therapeutic advances for major depression, a subset of patients with this disorder does not respond to conventional treatment. Stereotactic ablative procedures such as anterior cingulotomy have been performed in severely affected, treatment-resistant patients, but the long-term results of such procedures are not fully understood.


METHODS
Findings are reported for 33 patients with severe treatment-resistant major depression who underwent ablative stereotactic procedures (dorsal anterior cingulotomy followed if necessary by subcaudate tractotomy). Preoperative and long-term postoperative Beck Depression Inventory scores were obtained along with postoperative Clinical Global Improvement values. Both were analyzed to evaluate patients' responses to the surgical procedure(s).


RESULTS
At mean follow-up of 30 months after one or more stereotactic ablative procedures, 11 patients (33.3%) were classified as responders, 14 (42.4%) were partial responders, and 8 (24.2%) did not respond to the surgical procedure(s). Among those (17) who underwent only one procedure, seven (41.2%) responded, whereas six (35.3%) and four (23.5%) showed partial or no response, respectively. Among patients who required multiple surgical procedures, four patients (25%) responded, whereas eight (50%) and four (25%) patients demonstrated partial or no responses, respectively, at long-term follow-up evaluations.


CONCLUSIONS
Approximately 75% of depression patients previously resistant to antidepressant therapies received partial or substantial benefit from stereotactic ablative procedures. Those requiring only a single anterior cingulotomy tended to demonstrate more pronounced responses than patients who underwent multiple surgical procedures.
Shields
Donald C
DC
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02129, USA.
Asaad
Wael
W
Eskandar
Emad N
EN
Jain
Felipe A
FA
Cosgrove
G Rees
GR
Flaherty
Alice W
AW
Cassem
Edwin H
EH
Price
Bruce H
BH
Rauch
Scott L
SL
Dougherty
Darin D
DD
D055011:Ablation Techniques / Q000379:methods*; D000328:Adult; D000368:Aged; D001921:Brain / Q000033:anatomy & histology; D003865:Major Depressive Disorder / Q000601:surgery*; D005260:Female; D006179:Gyrus Cinguli / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation; D011446:Prospective Studies; D016634:Radiosurgery / Q000295:instrumentation*; D012720:Severity of Illness Index; D055815:Young Adult