Target identification and contact selection are known contributors to variability in efficacy across different clinical indications of deep brain stimulation surgery. A retrospective analysis of responders to subcallosal cingulate deep brain stimulation (SCC DBS) for depression demonstrated the common impact of the electrical stimulation on a stereotypic connectome of converging white matter bundles (forceps minor, uncinate fasciculus, cingulum and fronto-striatal fibers). To test the utility of a prospective connectomic approach for SCC DBS surgery, this pilot study used the four-bundle tractography 'connectome blueprint' to plan surgical targeting in 11 participants with treatment-resistant depression. Before surgery, targets were selected individually using deterministic tractography. Selection of contacts for chronic stimulation was made by matching the post-operative probabilistic tractography map to the pre-surgical deterministic tractography map for each subject. Intraoperative behavioral responses were used as a secondary verification of location. A probabilistic tract map of all participants demonstrated inclusion of the four bundles as intended, matching the connectome blueprint previously defined. Eight of 11 patients (72.7%) were responders and 5 were remitters after 6 months of open-label stimulation. At one year, 9 of 11 patients (81.8%) were responders, with 6 of them in remission. These results support the utility of a group probabilistic tractography map as a connectome blueprint for individualized, patient-specific, deterministic tractography targeting, confirming retrospective findings previously published. This new method represents a connectomic approach to guide future SCC DBS studies.

中文翻译：

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胼胝体下扣带回脑深部刺激手术的连接组学方法：治疗难治性抑郁症的前瞻性靶向。

众所周知，目标识别和接触选择是导致深部脑刺激手术不同临床适应症疗效差异的因素。对胼胝体下扣带回深部脑刺激 (SCC DBS) 治疗抑郁症的反应者进行的回顾性分析表明，电刺激对会聚白质束（钳小束、钩束、扣带回和额纹状体纤维）的刻板连接组有共同影响。为了测试前瞻性连接组学方法在鳞状细胞癌 DBS 手术中的实用性，这项试点研究使用四束纤维束成像“连接组蓝图”为 11 名患有难治性抑郁症的参与者制定手术目标。手术前，使用确定性纤维束成像单独选择目标。通过将每个受试者的术后概率性纤维束描记图与手术前的确定性纤维束描记图相匹配来选择用于慢性刺激的接触。术中行为反应被用作位置的二次验证。所有参与者的概率束图证明了四个束按预期包含在内，与之前定义的连接组蓝图相匹配。经过 6 个月的开放标签刺激后，11 名患者中有 8 名 (72.7%) 有反应，5 名有缓解。一年后，11 名患者中有 9 名（81.8%）有反应，其中 6 人病情缓解。这些结果支持群体概率纤维束成像图作为个体化、患者特异性、确定性纤维束成像目标的连接组蓝图的实用性，证实了先前发表的回顾性发现。这种新方法代表了一种指导未来 SCC DBS 研究的连接组学方法。