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Related Experiment Video

Updated: Nov 20, 2025

Exploring the Neural Correlates of Cognitive Reappraisal in Obsessive-Compulsive Disorder Using Task-based Functional Magnetic Resonance Imaging
09:14

Exploring the Neural Correlates of Cognitive Reappraisal in Obsessive-Compulsive Disorder Using Task-based Functional Magnetic Resonance Imaging

Published on: March 14, 2025

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Tractography-Guided Anterior Capsulotomy for Major Depression and Obsessive-Compulsive Disorder: Targeting the

Josue M Avecillas-Chasin1, Trevor A Hurwitz2, Nicholas M Bogod3

  • 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York.

Operative Neurosurgery (Hagerstown, Md.)
|January 21, 2021
PubMed
Summary

Tractography-guided bilateral anterior capsulotomy (BAC) precisely targets limbic pathways for treatment-resistant depression and obsessive-compulsive disorder. This method offers long-term benefits by minimizing damage to associative pathways.

Keywords:
Anterior capsulotomyAnterior limb of the internal capsuleAssociative. OCDCapsulotomyDeep brain stimulationDepressionFrontalFunctional neurosurgeryLesioningLimbicObsessive-compulsive disorderTractography

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Area of Science:

  • Neurosurgery
  • Neurology
  • Psychiatry

Background:

  • Bilateral anterior capsulotomy (BAC) is a treatment for major depression and obsessive-compulsive disorder.
  • Optimal lesion size and location in the anterior limb of the internal capsule (ALIC) are not well-defined.

Purpose of the Study:

  • To develop a method for identifying white matter pathways in the ALIC for precise BAC targeting.
  • To tailor capsulotomy lesions to limbic pathways using tractography.

Main Methods:

  • High-definition tractography was used to identify associative and limbic pathways within the ALIC.
  • This method was prospectively tested in two patients with treatment-resistant major depression (TRMD) and treatment-resistant obsessive-compulsive disorder (TROCD).

Main Results:

  • Limbic and associative pathways were successfully identified in both patients.
  • Lesions were targeted to limbic pathways, minimizing damage to associative pathways.
  • Achieved lesions were smaller than previously reported, with long-term benefits observed in both patients.

Conclusions:

  • Tractography-guided capsulotomy is a feasible surgical approach.
  • This technique provides long-term benefits for patients with TRMD and TROCD.