J Korean Neurosurg Soc.  2018 Jul;61(4):427-433. 10.3340/jkns.2017.0505.004.

The Potential Usefulness of Magnetic Resonance Guided Focused Ultrasound for Obsessive Compulsive Disorders

• Jung HH
• Chang WS
• Kim SJ
• Kim CH
• Chang JW

• KMID: 2417317
• DOI: http://doi.org/10.3340/jkns.2017.0505.004

Abstract

Obsessive compulsive disorder is a debilitating condition characterized by recurrent obsessive thoughts and compulsive reactions. A great portion of the obsessive compulsive disorder (OCD) patients are managed successfully with psychiatric treatment such as selective serotonin-reuptake inhibitor and cognitive behavioral psychotherapy, but more than 10% of patients are remained as non-responder who needs neurosurgical treatments. These patients are potential candidates for the neurosurgical management. There had been various kind of operation, lesioning such as leucotomy or cingulotomy or capsulotomy or limbic leucotomy, and with advent of stereotaxic approach and technical advances, deep brain stimulation was more chosen by neurosurgeon due to its characteristic of reversibility and adjustability. Gamma knife radiosurgery are also applied to make lesion targeting based on magnetic resonance (MR) imaging, but the complication of adverse radiation effect is not predictable. In the neurosurgical field, MR guided focused ultrasound has advantage of less invasiveness, real-time monitored procedure which is now growing to attempt to apply for various brain disorder. In this review, the neurosurgical treatment modalities for the treatment of OCD will be briefly reviewed and the current state of MR guided focused ultrasound for OCD will be suggested.

Keyword

Obsessive-compulsive disorder; Deep brain stimulation; Psychosurgery; High-intensity focused ultrasound ablation

MeSH Terms

Brain Diseases
Deep Brain Stimulation
High-Intensity Focused Ultrasound Ablation
Humans
Neurosurgeons
Obsessive-Compulsive Disorder
Psychosurgery
Psychotherapy
Radiation Effects
Radiosurgery
Ultrasonography*

Figure

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  Fig. 1. Magnetic resonance images of bilateral cingulotomy. Four lesions along two tracks were made on both side of the anterior cingulate gyrus. Fifteen mm posterior to the frontal horn of the lateral ventricle, 2 mm above the roof of the ventricle and 7 mm lateral to the midline was targeted, and after lesioning with 85°C for 90 seconds at first target, the electrode was withdrawn about 8 mm to produce second lesion (left : T2WI axial, middle : T1WI axial, right : T1WI coronal section).

• 

  Fig. 2. Postoperative MR images which were taken 6 months after bilateral capsulotomy with MRgFUS. There is no evidence of perilesional edema and the lesion was created exactly in the anterior limb of internal capsule (left : T2WI axial, right: T2WI coronal). MR : magnetic resonance, MRgFUS : magnetic resonance guided focused ultrasound.

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  Fig. 3. FDG positron emission tomography (PET) was acquired using high resolution research tomograph-PET (Siemens, Berlin, Germany) from eight patients before and 3 months after MRgFUS. PET images were reconstructed using the ordinary Poisson ordered subset expectation maximization 3D algorithm accelerated by symmetry and single instruction multiple data-based projection and a back-projection algorithm. Statistical parameter mapping software (SPM8, Wellcome Trust Center for Neuroimaging, London, UK) was used for preprocessing and voxel-based statistical processing. The standard uptake value ratio of 18 F-FDG was determined by normalizing the uptake value of each region of interest by the value of each patient’s centrum semiovale as a reference region. The orbitofrontal cortex showed decreased uptake significantly (p<0.001). FDG : fludeoxyglucose, MRgFUS : magnetic resonance guided focused ultrasound.

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