gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Deep Brain Stimulation – Where should we stimulate the medial forebrain bundle in psychiatric disorders?

Tiefe Hirnstimulation: In welchem Abschnitt sollte das mediale Vorderhirn-Bündel bei psychiatrischen Erkrankungen stimuliert werden?

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Jürgen Schlaier - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Valeria Demmel - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Nils-Ole Schmidt - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Daniel Deuter - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV114

doi: 10.3205/22dgnc115, urn:nbn:de:0183-22dgnc1153

Veröffentlicht: 25. Mai 2022

© 2022 Schlaier et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

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Objective: It has been suggested that the medial forebrain bundle (MFB) might be the structure to be stimulated in several psychiatric disorders. However, the MFB takes course over a long distance from the brainstem to the prefrontal cortex. Several targets on or nearby the path of the MFG have been tried in deep brain stimulation like the ventral anterior tegmentum (VAT), anteromedial subthalamic nucleus (amSTN) and the bed nucleus of the stria terminalis (BNST). In our study we investigated whether these stimulation sites are connected to the MFB exclusively or if other fiber tracts are involved?

Methods: 16 cerebral hemispheres in 8 patients with obsessive compulsive disorders were investigated. Three different regions of interest (ROI) were defined as seed regions for fiber tracking: the ventral anterior tegmentum (VAT), the anteromedial subthalamic nucleus (amSTN) and the bed nucleus of the stria terminalis (BNST). Tractography was executed on diffusion weighted images with 64 gradient directions from a 3T scanner and the patients under general anesthesia.

Results: The seed region in the BNST provided the most circumscribed depiction of the medial forebrain bundle with a limited amount of additional fibers and cortical and subcortical projection areas.

Seed regions in the VAT and the amSTN included the dentate-rubro-thalamic tract and fibers in the posterior and anterior limb of the internal capsule, projecting to large areas of the frontal and the motor cortex.

Conclusion: In deep brain stimulation the challenge is to find a well circumscribed target with maximum effect on symptom alleviation and no side effects. If the MFB was indeed the sole structure to be stimulated in certain psychiatric disorders, the BNST seems to be the best option. The BNST connects mainly and most exclusively to the MFB, whereas stimulation sites in the diencephalon involve significantly more fiber tracts and larger cortical projection areas.