title: Gamma-knife subcaudate tractotomy for treatment-resistant depression and target characteristics: a case report and review.
abstract: Stereotactic subcaudate tractotomy has previously been suggested to be an effective treatment for depression. This is the first study to report the use of gamma-knife subcaudate tractotomy for treatment-resistant depression. A 49-year-old woman with major depressive disorder had been treated for 30 years, with nine suicide attempts during that time. The right and left target maximum diameter was 11 mm within 50 % isodose lines. The target was located more posteriorly and inferiorly than the subgenual cingulate target typically used for deep-brain stimulation. The maximum radiation dose was 130 Gy. During the 4 months after surgery, the patient improved gradually from 23 to 4 according to the Hamilton Rating Scale for Depression and antidepressant medication was discontinued. Target-sized focal lesions were identified and no edema was seen postoperatively. No aggravation or neurologic deficit occurred during the 2.5 years of follow-up. Gamma-knife subcaudate tractotomy for depression is a minimally invasive technique. Investigations of the effectiveness and safety profile in a larger group are warranted.
authors.affiliation: Department of Neurosurgery, Asan Medical Center, 88, Olympic Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea.
authors.forename: Seong-Cheol
authors.initials: SC
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Asan Medical Center, 88, Olympic Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea. jklee2@icloud.com.|College of Medicine, University of Ulsan, 88, Olympic Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea. jklee2@icloud.com.
authors.forename: Jung Kyo
authors.identifier: 0000-0002-7290-5664
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Severance Hospital, Yonsei University, Seoul, Korea.
authors.forename: Chan-Hyung
authors.initials: CH
authors.lastname: Kim
authors.affiliation: College of Medicine, University of Ulsan, 88, Olympic Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea.|Department of Psychiatry, Asan Medical Center, Seoul, Korea.
authors.forename: Jin Pyo
authors.initials: JP
authors.lastname: Hong
authors.affiliation: Department of Neurosurgery, Asan Medical Center, 88, Olympic Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea.
authors.forename: Do Hee
authors.initials: DH
authors.lastname: Lee
mesh_terms: D003865:Major Depressive Disorder / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009434:Neural Pathways; D016634:Radiosurgery / Q000379:methods*
keywords: Depression; Gamma-knife radiosurgery; Subcaudate tractotomy