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- Title
Deep Brain Stimulation (DBS) of the Superolateral Branch of the Medial Forebrain Bundle (slMFB) in Psychiatric Disorders - Surgical Technique.
- Authors
Coenen, Volker Arnd; Schlaepfer, Thomas Eduard; Bewernick, Bettina H.; Bostroem, Jan; Reinacher, Peter Christoph; Greschus, Susanne; Urbach, Horst; Maedler, Burkhard
- Abstract
Background: Deep brain stimulation (DBS) of the superolateral branch of the medial forebrain bundle (slMFB) emerges as an interesting alternative - yet experimental - treatment for therapy refractory psychiatric diseases. First experiences have been reported from a pilot trial in major depression (1) and an uncontrolled case series for obsessive compulsive disorder (OCD) (2). Objective: To describe the surgical technique for deep brain stimulation (DBS) of the supero-lateral branch of the medial forebrain bundle (slMFB). To report our experience with the successful bilateral implantation in a larger patient group. Methods: Surgical experience from bilateral implantation procedures in n = 27 patients is reported. The detailed procedure of diffusion tensor imaging magnetic resonance imaging fiber tracking (DTI FT) assisted targeting together with detailed descriptive electrophysiology in 144 trajectories of the target region (recording and stimulation) and intraoperative testing are addressed. Results: In this early stage of experience, bilateral slMFB DBS requires DTI FT assisted targeting combined with in depth intraoperative electrophysiological investigation of the target region. Conclusion: The slMFB is a promising target region for the treatment of some psychiatric disorders (1,2). DTI FT assisted DBS of the slMFB is based on an imaging technology that is readily addressed in other indications (3,4). To the authors' knowledge the slMFB is the only target region for psychiatric disorders that allows for intra-operative testing with clear effects and side effects to guide implantation. In our eyes, this makes surgery of the slMFB is in many features comparable to typical movement disorder surgery.
- Publication
Stereotactic & Functional Neurosurgery, 2016, Vol 94, p47
- ISSN
1011-6125
- Publication type
Article
- DOI
10.1159/000448961