Background: Deep brain stimulation (DBS) has recently been discussed as a promising treatment option for severe cases of major depression. Experimental data have suggested that the lateral habenular complex (LHb-c) is a central region of depression-related neuronal circuits. Due to its location close to the midline, stereotactic targeting of the LHb-c confronts surgeons with distinct challenges.
Objective: To define the obstacles of DBS surgery for stimulation of the LHb-c and thus establish safe trajectories.
Methods: Stereotactic MRI datasets of 54 hemispheres originating from 27 DBS patients were taken for analysis on a stereotactic planning workstation. After alignment of images according to the ACPC-definition, analyses focused on vessels and enlarged ventricles interfering with trajectories.
Results: As major trajectory obstacles, (1) enlarged ventricles and (2) an interfering superior thalamic vein were found. A standard frontal trajectory (angle >40[degrees] relative to the ACPC in sagittal images) for bilateral stimulation was safely applicable in 48% of patients, whereas a steeper frontal-trajectory (angle <40[degrees] relative to ACPC in sagittal images) for bilateral stimulation was possible in 96%. Taken together, safe bilateral targeting of the LHb-c was possible in 98% of all patients.
Conclusion: Targeting LHb-c is a feasible and safe technique in the majority of patients undergoing surgery for DBS. However, meticulous individual planning to avoid interference with ventricles and thalamus-related veins is mandatory, as an alternative steep frontal entry point has to be considered in about half of the patients.
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