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Vol. 84, No. 5-6, 2006
Issue release date: November 2006
Stereotact Funct Neurosurg 2006;84:228–235

Tract Identification by Novel MRI Signal Changes following Stereotactic Anterior Capsulotomy

Hurwitz T.A. · Mandat T. · Forster B. · Honey C.
Departments of aPsychiatry and bRadiology and cDivision of Neurosurgery, University of British Columbia, Vancouver, Canada

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Background: Five patients underwent magnetic resonance imaging (MRI) following MRI-guided stereotactic bilateral anterior capsulotomy to detect lesion-related anatomic changes. Methods: Five disabled and treatment-resistant patients with major depression (n = 4) and obsessive-compulsive disorder (n = 1) underwent stereotactic bilateral anterior capsulotomy. All patients had postoperative MRI at 2 months and at 1–4 years after surgery. An additional patient who had a pure motor deficit following a spontaneous basal ganglia hemorrhagic stroke was imaged as a comparator. Results: The 2-month postcapsulotomy MRI showed a previously undescribed increase in T1-weighted signal within similar neural pathways for each patient. These pathways showed no changes in T2-weighted or fluid-attenuated inversion recovery sequences. The signal changes are different from the expected changes associated with anterograde Wallerian degeneration and identify retrograde changes in the proximal segment of the interrupted axon. Conclusion: Previously undescribed T1-weighted signal alterations following stereotactic surgery identify retrograde non-Wallerian changes in interrupted axons and provide a new method in identifying and tracing lesioned pathways.

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  1. Malhi G, Bartlett J: Depression: a role for neurosurgery. Br J Neurosurg 2000;14:415–423.
  2. Greenberg B, Price L, Rauch S, Friehs G, Noren G, Malone D, Carpenter L, Rezai A, Rasmussen S: Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues. Neurosurg Clin N Am 2003;14:199–212.
  3. Binder D, Iskander B: Modern neurosurgery for psychiatric disorders. Neurosurgery 2000;47:9–23.
  4. Mindus P, Jenike M: Neurosurgical treatment of malignant obsessive compulsive disorder. Psychiatr Clin North Am 1992;15:921–938.
  5. Marino R, Cosgrove G: Neurosurgical treatment of neuropsychiatric illness. Psychiatr Clin North Am 1997;20:933–943.
  6. Lippitz B, Mindus P, Meyerson B, Kihlstrom L, Lindquist C, Lunsford L, Gildenberg P, Kelly P, Bakay R: Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. Neurosurgery 1999;44:452–460.
  7. Mindus P: Present-day indications for capsulotomy. Acta Neurochir Suppl 1993;58:29–33.
  8. Richter E, Davis K, Hamani C, Hutchison W, Dostrovsky J, Lozano A: Cingulotomy for psychiatric disease: microelectrode guidance, a callosal reference system for documenting lesion location, and clinical results. Neurosurgery 2004;54:622–630.
  9. Dougherty DD, Baer L, Cosgrove GR, Cassem EH, Price BH, Nierenberg AA, Jenike MA, Rauch SL: Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder. Am J Psychiatry 2002;159:269–275.
  10. Malhi G, Bartlett J: A new lesion for the psychosurgical operation of stereotactic subcaudate tractotomy. Br J Neurosurg 1998;12:335–339.
  11. DeArmond SJ, Fusco MM, Dewey MM: Structure of the Human Brain. A Photographic Atlas. New York, Oxford University Press, 1976.
  12. Meyerson BA, Mindus P: The role of anterior internal capsulotomy in psychiatric surgery; in Lunsford L (ed): Modern Stereotactic Neurosurgery. Boston, Martinus Nijhoff Publishing, 1988, pp 353–364.
  13. Burnett MG, Zager EL: Pathophysiology of peripheral nerve injury: a brief review. Neurosurg Focus 2004;16:1–7.
  14. Jacobs WB, Fehlings MG: The molecular basis of neural regeneration. Neurosurgery 2003;53:943–950.
  15. Kuhn MJ, Johnson KA, Davis KR: Wallerian degeneration: evaluation with MR imaging. Radiology 1988;168:199–202.
  16. Kuhn MJ, Mikulis DJ, Ayoub DM, Kosofsky BE, Davis KR, Taveras JM: Wallerian degeneration after cerebral infarction: evaluation with sequential MR imaging. Radiology 1989;172:179–182.
  17. Inoue Y, Matsumura Y, Fukuda T, Nemoto Y, Shirahata N, Suzuki T, Shakudo M, Yawata S, Tanaka S, Takemoto K, Onoyama Y: MR imaging of Wallerian degeneration in the brainstem: temporal relationships. AJNR 1990;11:897–902.
  18. Khurana DS, Strawsburg RH, Robertson RL, Madsen J, Helmers S: MRI signal changes in the white matter after corpus callosotomy. Pediatr Neurol 1999;21:691–695.
  19. Sawlani V, Gupta RK, Singh MK, Kohli A: MRI demonstration of Wallerian degeneration in various intracranial lesions and its clinical implications. J Neurol Sci 1996;146:103–108.
  20. Becerra JL, Puckett WR, Hiester ED, Quencer RM, Marcillo AE, Post MJ, Bunge RP: MR-pathologic comparisons of Wallerian degeneration in spinal cord injury. Am J Neuroradiol 1995;16:125–133.
  21. Edelman R, Hesselink J, Newhouse J, Sartoris D: Clinical Magnetic Resonance Imaging. Philadelphia, Saunders, 1990.
  22. Freeman W, Watts JW: Retrograde degeneration of the thalamus following prefrontal lobotomy. J Comp Neurol 1947;86:65–93.

    External Resources

  23. Meyer A: A study of efferent connexions of the frontal lobe in the human brain after leucotomy. Brain 1949;72:265–299.
  24. Meyer A, Beck E: Neuropathological problems arising from frontal leukotomy. J Ment Sci 1945;91:411–425.
  25. Meyer A, Beck E, McLardy T: Prefrontal leucotomy: a neuro-anatomical report. Brain 1947;70:18–49.

    External Resources

  26. Axer H, Lippitz BE, Keyserlingk DG: Morphological asymmetry in anterior limb of human internal capsule revealed by confocal laser and polarized light microscopy. Psychiatry Res 1999;91:141–154.
  27. Spiegelmann R, Faibel M, Zohar Y: CT target selection in stereotactic anterior capsulotomy: anatomical considerations. In: Proceedings of the Xth Meeting of the World Society for Stereotactic and Functional Neurosurgery, 1994, Ixtapa, Mexico. Stereotact Funct Neurosurg 1994;63:160–167.
  28. Kandel EI: Functional and Stereotactic Neurosurgery. New York, Plenum Medical Book Company, 1989.
  29. Meyer A, Beck E: Prefrontal Leucotomy and Related Operations. Anatomical Aspects of Success and Failure. London, Oliver & Boyd, 1954.
  30. McLardy T: Thalamic projection to frontal cortex in man. J Neurol Neurosurg Psychiatry 1950;13:198–202.
  31. Drevets W: Prefrontal cortical-amygdalar metabolism in major depression. Ann NY Acad Sci 1999;877:614–637.
  32. Drevets WC: Neuroimaging studies of mood disorders. Biol Psychiatry 2000;48:813–829.
  33. Mayberg HS, Liotti M, Brannan SK, McGinnis S, Mahurin RK, Jerabek PA, Silva JA, Tekell JL, Martin CC, Lancaster JL, Fox PT: Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry 1999;156:675–682.
  34. Mayberg H, Brannan S, Tekell J, Silva A, Mahurin R, McGinnis S, Jerabek PA: Regional metabolic effects of fluoxetine in major depression: serial changes and relationship to clinical response. Biol Psychiatry 2000;48:830–843.
  35. Mayberg H, Lozano A, Voon V, McNeely H, Seminowicz D, Hamani C, Schwalb JM, Kennedy SH: Deep brain stimulation for treatment-resistant depression. Neuron 2005;45:651–660.
  36. Nauta W: Circuitous connections linking cerebral cortex, limbic system and corpus striatum; in Doane BK, Livingston KE (eds): The Limbic System. Functional Organization and Clinical Disorders. New York, Raven Press, 1986, pp 43–54.
  37. Beck E: The origin, course and termination of the prefronto-pontine tract in the human brain. Brain 1950;73:368–391.
  38. Middleton FA, Strick PL: Cerebellar projections to the prefrontal cortex of the primate. J Neurosci 2001;21:700–712.
  39. Schmahmann JD, Pandya JD: Anatomic organization of the basilar pontine projections from prefrontal cortices in rhesus monkey. J Neurosci 1997;17:438–458.
  40. Schmahmann JD, Sherman JC: The cerebellar cognitive affective syndrome. Brain 1998;121:561–579.

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