Lesion location and outcome following cingulotomy for obsessive-compulsive disorder

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  • 1 Departments of Neurosurgery and
  • | 2 Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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OBJECTIVE

Obsessive-compulsive disorder (OCD) is among the most debilitating and medically refractory psychiatric disorders. While cingulotomy is an anatomically targeted neurosurgical treatment that has shown significant promise in treating OCD-related symptoms, the precise underlying neuroanatomical basis for its beneficial effects has remained poorly understood. Therefore, the authors sought to determine whether lesion location is related to responder status following cingulotomy.

METHODS

The authors reviewed the records of 18 patients who had undergone cingulotomy. Responders were defined as patients who had at least a 35% improvement in the Yale-Brown Obsessive Compulsive Scale (YBOCS) score. The authors traced the lesion sites on T1-weighted MRI scans and used an anatomical registration matrix generated by the imaging software FreeSurfer to superimpose these lesions onto a template brain. Lesion placement was compared between responders and nonresponders. The placement of lesions relative to various anatomical regions was also compared.

RESULTS

A decrease in postoperative YBOCS score was significantly correlated with more superiorly placed lesions (decrease −0.52, p = 0.0012). While all lesions were centered within 6 mm of the cingulate sulcus, responder lesions were placed more superiorly and posteriorly along the cingulate sulcus (1-way ANOVA, p = 0.003). The proportions of the cingulum bundle, cingulate gyrus, and paracingulate cortex affected by the lesions were the same between responders and nonresponders. However, all responders had lesions covering a larger subregion of Brodmann area (BA) 32. In particular, responder lesions covered a significantly greater proportion of the posterior BA32 (1-way ANOVA, p = 0.0064).

CONCLUSIONS

Lesions in patients responsive to cingulotomy tended to be located more superiorly and posteriorly and share greater coverage of a posterior subregion of BA32 than lesions in patients not responsive to this treatment.

ABBREVIATIONS

BA = Brodmann area; BDI = Beck Depression Inventory; BOLD = blood oxygen level–dependent; CB = cingulum bundle; CC = cingulate cortex; CS = cingulate sulcus; CSTC = cortico-striato-thalamo-cortical; DBS = deep brain stimulation; fMRI = functional MRI; MGH = Massachusetts General Hospital; MNI = Montreal Neurological Institute; OCD = obsessive-compulsive disorder; PC = paracingulate cortex; ROI = region of interest; STN = subthalamic nucleus; YBOCS = Yale-Brown Obsessive Compulsive Scale.

Illustration from Schneider et al. (pp 205–214). Copyright Elyssa Siegel. Published with permission.

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