title: Targeting bed nucleus of the stria terminalis for severe obsessive-compulsive disorder: more unexpected lead placement in obsessive-compulsive disorder than in surgery for movement disorders.
abstract: BACKGROUND
  In preparation for a multicenter study, a protocol was written on how to perform surgical targeting of the bed nucleus of the stria terminalis, based on the lead implantation experience in patients with treatment-refractory obsessive-compulsive disorder (OCD) at the Universitaire Ziekenhuizen Leuven (UZ Leuven). When analyzing the postoperative images, we were struck by the fact that the difference between the postoperative position of the leads and the planned position seemed larger than expected.
  
  
  METHODS
  The precision of targeting in four patients with severe OCD who received bilateral model 3391 leads (Medtronic) was compared with the precision of targeting in the last seven patients who underwent surgery at UZ Leuven for movement disorders (four with Parkinson disease and three with essential tremor; all received bilateral leads). Because the leads implanted in six of the seven patients with movement disorders were model 3387 leads (Medtronic), targeting precision was also analyzed in four patients with OCD in whom model 3387 leads were implanted in the same target as the other patients with OCD.
  
  
  RESULTS
  In the patients with OCD, every implanted lead deviated at least 1.3 mm from its intended position in at least one of three directions (lateral, anteroposterior, and depth), whereas in the patients with movement disorders, the maximal deviation of any of all implanted leads was 1.3 mm. The deviations in lead placement were comparable in patients with OCD who received a model 3387 implant and patients who received a model 3391 implant. In the patients with OCD, all leads were implanted more posteriorly than planned.
  
  
  CONCLUSIONS
  The cause of the posterior deviation could not be determined with certainty. The most likely cause was an increased mechanical resistance of the brain tissue along the trajectory when following the targeting protocol compared with the trajectories classically used for subthalamic nucleus or ventral intermediate nucleus of the thalamus stimulation.
authors.affiliation: Department of Neurosurgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium; Laboratory of Experimental Neurosurgery and Neuroanatomy, Katholieke Universiteit Leuven, Leuven, Belgium. Electronic address: bart.nuttin@uzleuven.be.
authors.forename: Bart
authors.initials: B
authors.lastname: Nuttin
authors.forename: Frans
authors.initials: F
authors.lastname: Gielen
authors.forename: Kris
authors.initials: K
authors.lastname: van Kuyck
authors.forename: Hemmings
authors.initials: H
authors.lastname: Wu
authors.forename: Laura
authors.initials: L
authors.lastname: Luyten
authors.forename: Marleen
authors.initials: M
authors.lastname: Welkenhuysen
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Brionne
authors.forename: Loes
authors.initials: L
authors.lastname: Gabriëls
mesh_terms: D001921:Brain / Q000473:pathology / Q000601:surgery; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted; D020329:Essential Tremor / Q000628:therapy; D008279:Magnetic Resonance Imaging; D009069:Movement Disorders / Q000601:surgery*; D009771:Obsessive-Compulsive Disorder / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D010300:Parkinson Disease / Q000628:therapy; D012686:Septal Nuclei / Q000502:physiology*