Stereo-EEG-guided network modulation for psychiatric disorders: Surgical considerations

Area of Science:

• Neuroscience
• Neurosurgery
• Psychiatry

Background:

• Refractory neurologic and psychiatric disorders are increasingly treated with neuromodulatory techniques like deep brain stimulation (DBS).
• Treatment-resistant depression (TRD) presents a significant challenge due to its complex network-level dysfunction.

Purpose of the Study:

• To understand the circuit-level pathophysiology of TRD.
• To treat network-level dysfunction in TRD using an innovative intracranial monitoring approach.
• To combine DBS with stereo-electroencephalography (sEEG) for enhanced neurophysiological assessment.

Main Methods:

• Implanted 3 patients with DBS leads (ventral capsule/striatum and subcallosal cingulate) and sEEG electrodes targeting depression-relevant brain regions.
• Utilized holographic visualization for surgical planning and robotic stereotaxy for electrode placement.
• Conducted inpatient neurophysiological assessments followed by sEEG electrode removal and DBS lead internalization.

Main Results:

• Intraoperative testing confirmed positive valence responses, validating the surgical targeting in all subjects.
• Demonstrated accurate adherence to the surgical plan and stable DBS lead positioning, crucial for chronic stimulation and accurate field estimates.
• Achieved mean radial error of 1.2±0.9 mm and mean rotation of 3.6±2.6° for DBS leads.

Conclusions:

• The novel hybrid sEEG-DBS approach enables detailed investigation of neurophysiological substrates in complex neuropsychiatric disorders.
• This method provides a powerful tool for studying and potentially treating conditions like TRD.