title: Variability and anatomical specificity of the orbitofrontothalamic fibers of passage in the ventral capsule/ventral striatum (VC/VS): precision care for patient-specific tractography-guided targeting of deep brain stimulation (DBS) in obsessive compulsive disorder (OCD).
abstract: Deep Brain Stimulation (DBS) is a neurosurgical procedure that can reduce symptoms in medically intractable obsessive-compulsive disorder (OCD). Conceptually, DBS of the ventral capsule/ventral striatum (VC/VS) region targets reciprocal excitatory connections between the orbitofrontal cortex (OFC) and thalamus, decreasing abnormal reverberant activity within the OFC-caudate-pallidal-thalamic circuit. In this study, we investigated these connections using diffusion magnetic resonance imaging (dMRI) on human connectome datasets of twenty-nine healthy young-adult volunteers with two-tensor unscented Kalman filter based tractography. We studied the morphology of the lateral and medial orbitofrontothalamic connections and estimated their topographic variability within the VC/VS region. Our results showed that the morphology of the individual orbitofrontothalamic fibers of passage in the VC/VS region is complex and inter-individual variability in their topography is high. We applied this method to an example OCD patient case who underwent DBS surgery, formulating an initial proof of concept for a tractography-guided patient-specific approach in DBS for medically intractable OCD. This may improve on current surgical practice, which involves implanting all patients at identical stereotactic coordinates within the VC/VS region.
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA. nikos@cma.mgh.harvard.edu.|Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. nikos@cma.mgh.harvard.edu.|McLean Imaging Center, McLean Hospital, Harvard Medical School, Boston, MA, USA. nikos@cma.mgh.harvard.edu.|Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA. nikos@cma.mgh.harvard.edu.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Makris
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.|Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Rathi
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.
authors.forename: Palig
authors.initials: P
authors.lastname: Mouradian
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bonmassar
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.
authors.forename: George
authors.initials: G
authors.lastname: Papadimitriou
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.
authors.forename: Wingkwai I
authors.initials: WI
authors.lastname: Ing
authors.affiliation: Department of Psychology, Colby College, Waterville, ME, USA.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Yeterian
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.|Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Marek
authors.initials: M
authors.lastname: Kubicki
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.
authors.forename: Emad N
authors.initials: EN
authors.lastname: Eskandar
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.
authors.forename: Lawrence L
authors.initials: LL
authors.lastname: Wald
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.
authors.forename: Qiuyun
authors.initials: Q
authors.lastname: Fan
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.
authors.forename: Aapo
authors.initials: A
authors.lastname: Nummenmaa
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.|Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.
authors.forename: Alik S
authors.initials: AS
authors.lastname: Widge
authors.affiliation: Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA.
authors.forename: Darin D
authors.initials: DD
authors.lastname: Dougherty
mesh_terms: D000328:Adult; D063132:Connectome; D066264:Datasets as Topic; D046690:Deep Brain Stimulation; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D019635:Neurosurgical Procedures; D009771:Obsessive-Compulsive Disorder / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D057285:Precision Medicine; D017397:Prefrontal Cortex / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D025321:Surgery, Computer-Assisted; D013788:Thalamus / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D066328:Ventral Striatum / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult
keywords: Connectome; Deep brain stimulation (DBS); Diffusion tensor imaging; Diffusion tractography; Obsessive-compulsive disorder (OCD); Tractography-guided DBS