Safety and precision of frontal trajectory of lateral habenula deep brain stimulation surgery in treatment-resistant depression

Zhiqiang Cui; Chao Jiang; Chunhua Hu; Ye Tian; Zhipei Ling; Jian Wang; Tengteng Fan; Hongwei Hao; Zhiyan Wang; Luming Li

doi:10.3389/fneur.2023.1113545

Safety and precision of frontal trajectory of lateral habenula deep brain stimulation surgery in treatment-resistant depression

Front Neurol. 2023 Mar 16:14:1113545. doi: 10.3389/fneur.2023.1113545. eCollection 2023.

Authors

Zhiqiang Cui¹, Chao Jiang², Chunhua Hu³, Ye Tian³, Zhipei Ling⁴, Jian Wang¹, Tengteng Fan⁵, Hongwei Hao³, Zhiyan Wang^{3

6}, Luming Li^{3

7

8

9}

Affiliations

¹ Department of Neurosurgery, Chinese People's Liberation Army of China General Hospital, Beijing, China.
² College of Life and Health Sciences, Institute of Neuroscience, Northeastern University, Shenyang, Liaoning, China.
³ National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.
⁴ Chinese People's Liberation Army General Hospital Hainan Hospital Neurosurgery, Sanya, Hainan, China.
⁵ Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Six Hospital), Beijing, China.
⁶ Chinese Academy of Sciences Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
⁷ Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China.
⁸ International Data Group/McGovern Institute for Brain Research at Tsinghua University, Beijing, China.
⁹ Institute of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.

Abstract

Introduction: The lateral habenula (LHb) is a promising deep brain stimulation (DBS) target for treatment-resistant depression (TRD). However, the optimal surgical trajectory and its safety of LHb DBS are lacking.

Methods: We reported surgical trajectories for the LHb in six TRD patients treated with DBS at the General Hospital of the Chinese People's Liberation Army between April 2021 and May 2022. Pre-operative fusions of magnetic resonance imaging (MRI) and computed tomography (CT) were conducted to design the implantation trajectory of DBS electrodes. Fusions of MRI and CT were conducted to assess the safety or precision of LHb DBS surgery or implantable electrodes locations.

Results: Results showed that the optimal entry point was the posterior middle frontal gyrus. The target coordinates (electrode tips) were 3.25 ± 0.82 mm and 3.25 ± 0.82 mm laterally, 12.75 ± 0.42 mm and 13.00 ± 0.71 mm posterior to the midpoint of the anterior commissure-posterior commissure (AC-PC) line, and 1.83 ± 0.68 mm and 1.17 ± 0.75 mm inferior to the AC-PC line in the left and right LHb, respectively. The "Ring" angles (relative to the AC-PC level on the sagittal section plane) of the trajectories to the left and right LHb were 51.87° ± 6.67° and 52.00° ± 7.18°, respectively. The "Arc" angles (relative to the midline of the sagittal plane) were 33.82° ± 3.39° and 33.55° ± 3.72°, respectively. Moreover, there was small deviation of actual from planned target coordinates. No patient had surgery-, disease- or device-related adverse events during the perioperative period.

Conclusion: Our results suggested that LHb-DBS surgery via frontal trajectory is safe, accurate, and feasible. This is an applicable work to report in detail the target coordinates and surgical path of human LHb-DBS. It has of great clinical reference value to treat more cases of LHb-DBS for TRD.

Keywords: deep brain stimulation; frontal trajectory; lateral habenula; safety; treatment-resistant depression.

Grants and funding

This work was supported by the National Key Research and Development Program of China (2019YFC0118500) and the National Natural Science Foundation of China (Grant No. 82101549).