Letter to the Editor: Augmented reality–guided neurosurgery
Vincenzo Ferrari, Fabrizio Cutolo · Journal of neurosurgery · 2016
These authors summarize cur-rent understanding of the pathophysiology of schizophrenia based on dysfunction in dopaminergic and glutamatergic signaling.They suggest several nodes of the basal ganglia-thalamocortical circuit as therapeutic targets for deep brain stimulation (DBS): the hippocampus, the ventral striatum, and the associative striatum.3 Regarding this dopamine dysregulation-based hypothesis, we believe that there are other targets that could be useful for DBS: the mediodorsal thalamus and the internal globus pallidus.1,4,5,9 Moreover, in the last few years, findings from voxel-based morphometry, diffusion tensor imaging, and functional MRI suggest structure and functional alterations of the medial prefrontal cortex, specifically the area correlated to the anterior midline node of the default mode network.6,8 This area corresponds to the subcallosal cingulate gyrus, which includes Brodmann area 25.The failure of task-related deactivation in this medial frontal cortex is related to the symptoms of schizophrenia.Actually, a meta-analysis of the whole-brain voxel-based approach revealed that abnormalities in white matter areas in schizophrenia were consistently identified across the studies in only 2 locations, one of them corresponding to this anterior cingulate subgenual area. 2 This region has been stimulated with DBS in other neuropsychiatric disorders, and in our experience in treatment-resistant depression, no associated complications have been observed.7 We suggest that this could be another possible target for the treatment of resistant schizophrenia.Schizophrenia remains one of the leading causes of disability worldwide, with 30% of patients refractory to treatment.We agree that given the severity of this disease and its high consumption of resources, new treatment strategies are needed.We are conducting a prospective, randomized, double-blind clinical trial (clinical trial no.: NCT02377505, clinicaltrials.gov)aimed at assessing the tolerability and efficacy of DBS in refractory schizophrenia (founding Grant Nos.PI12/00042 [E.