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Noninvasive Capsulotomy for Refractory Depression by Frameless Stereotactic Radiosurgery
Mohamed H Khattab1, Alexander D Sherry2, Sean P Devan3
1Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee; Minneapolis Radiation Oncology, Edina, Minnesota.
Summary
Radiosurgical capsulotomy effectively treats refractory depression by altering brain connectivity. This novel approach shows significant symptom improvement and no cognitive decline in patients.
Area of Science:
- Neurology
- Neurosurgery
- Psychiatry
Background:
- Refractory depression lacks effective treatments.
- Advancements in radiation and neuroimaging enable new therapeutic approaches.
Purpose of the Study:
- To evaluate stereotactic radiosurgical capsulotomy for major depressive disorder.
- To analyze functional connectome response using tractography.
Main Methods:
- Prospective pilot study of 3 patients with refractory depression.
- Bilateral anterior limb of internal capsule ablation via stereotactic radiosurgery.
- Efficacy measured by Beck's Depression Inventory; cognition by Montreal Cognitive Assessment.
Main Results:
- Significant depression burden reduction (up to 88%) at 12-month follow-up.
- Resolution of suicidal ideation in all patients.
- Improved cognitive function and no neurologic toxicity observed.
- Tractography confirmed cortico-striatal-thalamo-cortical loop disruption and reorganization.
Conclusions:
- Radiosurgical capsulotomy significantly reduces depression in refractory cases.
- Functional connectome reorganization provides neurobiological support for radiosurgery in depression treatment.
