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The History and Future of Ablative Neurosurgery for Major Depressive Disorder.
Stereotact Funct Neurosurg 2017; 95(4):216-228SF

Abstract

BACKGROUND

There is an urgent need to develop safe and effective treatments for patients with treatment-resistant depression (TRD). Several neurosurgical procedures have been developed to treat the dysfunctional brain circuits implicated in major depression.

OBJECTIVES

This review describes the most common ablative procedures used to treat major depressive disorder: anterior cingulotomy, subcaudate tractotomy, limbic leucotomy, and anterior capsulotomy. The efficacy and safety of each are discussed and compared with other current and emerging modalities, including deep brain stimulation (DBS) and MR-guided focused ultrasound (MRgFUS).

METHODS

The PubMed and MEDLINE electronic databases were used in this study, through July 2016. Keywords, including "treatment resistant depression," and "ablative neurosurgery," etc. were used to generate reference hits.

RESULTS

Approximately a third to half of patients who underwent ablative procedures achieved a treatment response and/or remission. The efficacy and safety profiles corresponding to both ablative procedures and DBS were very similar.

CONCLUSIONS

The longitudinal experience with ablative procedures shows that there remains an important role for accurate, discrete lesions in disrupting affective circuitry in the treatment of TRD. New modalities, such as MRgFUS, have the potential to further improve the accuracy of ablative procedures, while enhancing safety by obviating the need for open brain surgery.

Authors+Show Affiliations

Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28723697

Citation

Volpini, Matthew, et al. "The History and Future of Ablative Neurosurgery for Major Depressive Disorder." Stereotactic and Functional Neurosurgery, vol. 95, no. 4, 2017, pp. 216-228.
Volpini M, Giacobbe P, Cosgrove GR, et al. The History and Future of Ablative Neurosurgery for Major Depressive Disorder. Stereotact Funct Neurosurg. 2017;95(4):216-228.
Volpini, M., Giacobbe, P., Cosgrove, G. R., Levitt, A., Lozano, A. M., & Lipsman, N. (2017). The History and Future of Ablative Neurosurgery for Major Depressive Disorder. Stereotactic and Functional Neurosurgery, 95(4), pp. 216-228. doi:10.1159/000478025.
Volpini M, et al. The History and Future of Ablative Neurosurgery for Major Depressive Disorder. Stereotact Funct Neurosurg. 2017;95(4):216-228. PubMed PMID: 28723697.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The History and Future of Ablative Neurosurgery for Major Depressive Disorder. AU - Volpini,Matthew, AU - Giacobbe,Peter, AU - Cosgrove,G Rees, AU - Levitt,Anthony, AU - Lozano,Andres M, AU - Lipsman,Nir, Y1 - 2017/07/20/ PY - 2017/01/05/received PY - 2017/06/05/accepted PY - 2017/7/21/pubmed PY - 2018/8/14/medline PY - 2017/7/21/entrez KW - Major depressive disorder KW - Neurosurgery for mental disease KW - Treatment-resistant depression SP - 216 EP - 228 JF - Stereotactic and functional neurosurgery JO - Stereotact Funct Neurosurg VL - 95 IS - 4 N2 - BACKGROUND: There is an urgent need to develop safe and effective treatments for patients with treatment-resistant depression (TRD). Several neurosurgical procedures have been developed to treat the dysfunctional brain circuits implicated in major depression. OBJECTIVES: This review describes the most common ablative procedures used to treat major depressive disorder: anterior cingulotomy, subcaudate tractotomy, limbic leucotomy, and anterior capsulotomy. The efficacy and safety of each are discussed and compared with other current and emerging modalities, including deep brain stimulation (DBS) and MR-guided focused ultrasound (MRgFUS). METHODS: The PubMed and MEDLINE electronic databases were used in this study, through July 2016. Keywords, including "treatment resistant depression," and "ablative neurosurgery," etc. were used to generate reference hits. RESULTS: Approximately a third to half of patients who underwent ablative procedures achieved a treatment response and/or remission. The efficacy and safety profiles corresponding to both ablative procedures and DBS were very similar. CONCLUSIONS: The longitudinal experience with ablative procedures shows that there remains an important role for accurate, discrete lesions in disrupting affective circuitry in the treatment of TRD. New modalities, such as MRgFUS, have the potential to further improve the accuracy of ablative procedures, while enhancing safety by obviating the need for open brain surgery. SN - 1423-0372 UR - https://www.unboundmedicine.com/medline/citation/28723697/The_History_and_Future_of_Ablative_Neurosurgery_for_Major_Depressive_Disorder L2 - https://www.karger.com?DOI=10.1159/000478025 DB - PRIME DP - Unbound Medicine ER -