title: A connectomic approach for subcallosal cingulate deep brain stimulation surgery: prospective targeting in treatment-resistant depression.
abstract: Target identification and contact selection are known contributors to variability in efficacy across different clinical indications of deep brain stimulation surgery. A retrospective analysis of responders to subcallosal cingulate deep brain stimulation (SCC DBS) for depression demonstrated the common impact of the electrical stimulation on a stereotypic connectome of converging white matter bundles (forceps minor, uncinate fasciculus, cingulum and fronto-striatal fibers). To test the utility of a prospective connectomic approach for SCC DBS surgery, this pilot study used the four-bundle tractography 'connectome blueprint' to plan surgical targeting in 11 participants with treatment-resistant depression. Before surgery, targets were selected individually using deterministic tractography. Selection of contacts for chronic stimulation was made by matching the post-operative probabilistic tractography map to the pre-surgical deterministic tractography map for each subject. Intraoperative behavioral responses were used as a secondary verification of location. A probabilistic tract map of all participants demonstrated inclusion of the four bundles as intended, matching the connectome blueprint previously defined. Eight of 11 patients (72.7%) were responders and 5 were remitters after 6 months of open-label stimulation. At one year, 9 of 11 patients (81.8%) were responders, with 6 of them in remission. These results support the utility of a group probabilistic tractography map as a connectome blueprint for individualized, patient-specific, deterministic tractography targeting, confirming retrospective findings previously published. This new method represents a connectomic approach to guide future SCC DBS studies.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Riva-Posse
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Choi
authors.affiliation: Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Holtzheimer
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Crowell
authors.affiliation: Department of Psychiatry, University of Wisconsin, Madison, WI, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Garlow
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Rajendra
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: McIntyre
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.|Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.|Coulter Department of Biomedical Engineering, Emory University, Atlanta, GA, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Gross
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.|Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.|Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: H S
authors.initials: HS
authors.lastname: Mayberg
mesh_terms: D000328:Adult; D063132:Connectome / Q000379:methods; D046690:Deep Brain Stimulation / Q000379:methods*; D003863:Depression / Q000628:therapy; D003865:Major Depressive Disorder / Q000628:therapy; D061218:Depressive Disorder, Treatment-Resistant / Q000503:physiopathology / Q000628:therapy*; D056324:Diffusion Tensor Imaging; D005260:Female; D006179:Gyrus Cinguli / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009415:Nerve Net; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000378:metabolism / Q000502:physiology* / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D066127:White Matter / Q000502:physiology