BACKGROUND: Deep brain stimulation (DBS) has recently been discussed as a promising treatment option for severe cases of major depression. Experimental data have suggested that the lateral habenular complex (LHb-c) is a central region of depression-related neuronal circuits. Because of its location close to the midline, stereotactic targeting of the LHb-c presents surgeons with distinct challenges.
OBJECTIVE: To define the obstacles of DBS surgery for stimulation of the LHb-c and thus to establish safe trajectories.
METHODS: Stereotactic magnetic resonance imaging data sets of 54 hemispheres originating from 27 DBS patients were taken for analysis on a stereotactic planning workstation. After alignment of images according to the anterior commissure--posterior commissure definition, analyses focused on vessels and enlarged ventricles interfering with trajectories.
RESULTS: As major trajectory obstacles, enlarged ventricles and an interfering superior thalamic vein were found. A standard frontal trajectory (angle > 40° relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was safely applicable in 48% of patients, whereas a steeper frontal trajectory (angle <40 relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was possible in 96%. Taken together, safe bilateral targeting of the LHb-c was possible in 98% of all patients.
CONCLUSION: Targeting LHb-c is a feasible and safe technique in the majority of patients undergoing surgery for DBS. However, meticulous individual planning to avoid interference with ventricles and thalamus-related veins is mandatory because an alternative steep frontal entry point has to be considered in about half of the patients.
ABBREVIATIONS: AC-PC, anterior commissure--posterior commissure
DBS, deep brain stimulation
LHb-c, lateral habenular complex
MHb, medial habenula
STV, superior thalamic vein
*Division of Stereotactic Neurosurgery, Department of Neurosurgery, Universitätsklinikum Heidelberg, Heidelberg, Germany;
‡Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
Correspondence: Karl Kiening, MD, PhD, Head, Division of Stereotactic Neurosurgery, Department of Neurosurgery, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. E-mail: email@example.com
Received June 28, 2012
Accepted September 20, 2012