Bilateral Epidural Prefrontal Cortical Stimulation for Treatment-Resistant Depression

Surgical planning and electrodes placement. Before surgery, the region of interests (Brodmann's areas [BA] 10 and 46 bilaterally) were identified and highlighted on each subject's magnetic resonance imaging (MRI) scan (A and B). In the operating room, the patient's head was coregistered with the MRI image using a stereotactic frameless system (BrainLab, Westchester, Illinois). A three-dimensional rendering displayed the head surface anatomy in native space with bilateral BA 10 and 46 in distinctive colors. An external wand helped identify landmarks of interest for accurate position of the leads. (A–C) The external wand pointing at the right midlateral region of interest (BA 46). The surgical team used intraoperative fluoroscopy (D) in conjunction with the stereotactic frameless system to optimize targeting accuracy.

Mean and standard error in 24-item Hamilton Rating Scale for Depression patients over time in five treatment-resistant depression-treated with adjunctive anterior pole and midlateral epidural prefrontal cortical electrical stimulation.