• Nikolaos Makris, Yogesh Rathi, Palig Mouradian, Giorgio Bonmassar, George Papadimitriou, Wingkwai I Ing, Edward H Yeterian, Marek Kubicki, Emad N Eskandar, Lawrence L Wald, Qiuyun Fan, Aapo Nummenmaa, Alik S Widge, and Darin D Dougherty.
• Departments of Psychiatry, Neurology, Neurosurgery and Radiology, Center for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, MA, 02129, USA. nikos@cma.mgh.harvard.edu.
• Brain Imaging Behav. 2016 Dec 1; 10 (4): 1054-1067.

AbstractDeep Brain Stimulation (DBS) is a neurosurgical procedure that can reduce symptoms in medically intractable obsessive-compulsive disorder (OCD). Conceptually, DBS of the ventral capsule/ventral striatum (VC/VS) region targets reciprocal excitatory connections between the orbitofrontal cortex (OFC) and thalamus, decreasing abnormal reverberant activity within the OFC-caudate-pallidal-thalamic circuit. In this study, we investigated these connections using diffusion magnetic resonance imaging (dMRI) on human connectome datasets of twenty-nine healthy young-adult volunteers with two-tensor unscented Kalman filter based tractography. We studied the morphology of the lateral and medial orbitofrontothalamic connections and estimated their topographic variability within the VC/VS region. Our results showed that the morphology of the individual orbitofrontothalamic fibers of passage in the VC/VS region is complex and inter-individual variability in their topography is high. We applied this method to an example OCD patient case who underwent DBS surgery, formulating an initial proof of concept for a tractography-guided patient-specific approach in DBS for medically intractable OCD. This may improve on current surgical practice, which involves implanting all patients at identical stereotactic coordinates within the VC/VS region.

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