Objective: To describe in as much detail as possible the method for ablating the ventromedial shell of the nucleus accumbens (NAc) and investigate the efficacy and safety of the ablation treatment. Methods: Sixty-five patients with drug addictions received operations within the time frame from 2004 to 2009. The ablation targets were located in the bilateral medial posterior inferior shell of the NAc. Intraoperative electrophysiological monitoring was performed. Results: Tissue impedance in the shell of the NAc varied from 185 to 355 Ω. When stimulated with a low frequency (2 Hz) and a voltage above 3 V, 57 out of 65 (87.7%) patients experienced slight throbbing sensations. During the lesion procedure, fever was detected on the head and face of 59 patients (90.8%), the heart rate decreased in 19 cases (29.2%), and restlessness, irritability and hyperalgia were noted for all patients. Among the 65 patients, 52 (80%) no longer experienced a psychological craving for the drug. Conclusions: The shell of the NAc may be a promising surgical target for psychosurgery. Electrophysiological recordings revealed that the shell is indeed an appropriate structure.

Journal Section:
Editor's choice
Keywords:
Nucleus accumbens, Stereotaxy, Electrophysiological monitoring, Obsessive-compulsive psychiatric disorders
1.
Eisch AJ, Bolanos CA, de Wit J, Simonak RD, Pudiak CM, Barrot M, Verhaagen J, Nestler EJ: Brain-derived neurotrophic factor in the ventral midbrain-nucleus accumbens pathway: a role in depression. Biol Psychiatry 2003;54:994-1005.
[PubMed]
https://doi.org/10.1016%2Fj.biopsych.2003.08.003
2.
Perreault ML, Hasbi A, Alijaniaram M, Fan T, Varghese G, Fletcher PJ, Seeman P, O'Dowd BF, George SR: The dopamine D1-D2 receptor heteromer localizes in dynorphin/enkephalin neurons: increased high affinity state following amphetamine and in schizophrenia. J Biol Chem 2010;285:36625-36634.
[PubMed]
https://doi.org/10.1074%2Fjbc.M110.159954
3.
Denys D, Mantione M, Figee M, van den Munckhof P, Koerselman F, Westenberg H, Bosch A, Schuurman R: Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 2010;67:1061-1068.
[PubMed]
https://doi.org/10.1001%2Farchgenpsychiatry.2010.122
4.
Drevets WC, Gautier C, Price JC, Kupfer DJ, Kinahan PE, Grace AA, Price JL, Mathis CA: Amphetamine-induced dopamine release in human ventral striatum correlates with euphoria. Biol Psychiatry 2001;49:81-96.
[PubMed]
https://doi.org/10.1016%2FS0006-3223%2800%2901038-6
5.
Boileau I, Assaad JM, Pihl RO, Benkelfat C, Leyton M, Diksic M, Tremblay RE, Dagher A: Alcohol promotes dopamine release in the human nucleus accumbens. Synapse 2003;49:226-231.
[PubMed]
https://doi.org/10.1002%2Fsyn.10226
6.
Voorn P, Brady LS, Schotte A, Berendse HW, Richfield EK: Evidence for two neurochemical divisions in the human nucleus accumbens. Eur J Neurosci 1994;6:1913-1916.
[PubMed]
https://doi.org/10.1111%2Fj.1460-9568.1994.tb00582.x
7.
Meredith GE, Pattiselanno A, Groenewegen HJ, Haber SN: Shell and core in monkey and human nucleus accumbens identified with antibodies to calbindin-D28k. J Comp Neurol 1996;365:628-639.
[PubMed]
https://doi.org/10.1002%2F%28SICI%291096-9861%2819960219%29365%3A4%3C628%3A%3AAID-CNE9%3E3.0.CO%3B2-6
8.
Voorn P, Brady LS, Berendse HW, Richfield EK: Densitometrical analysis of opioid receptor ligand binding in the human striatum. 1. Distribution of mu opioid receptor defines shell and core of the ventral striatum. Neuroscience 1996;75:777-792.
[PubMed]
https://doi.org/10.1016%2F0306-4522%2896%2900271-0
9.
Groenewegen HJ, Wright CI, Beijer AV: The nucleus accumbens: gateway for limbic structures to reach the motor system? Prog Brain Res 1996;107:485-511.
[PubMed]
https://doi.org/10.1016%2FS0079-6123%2808%2961883-X
10.
Bassareo V, De Luca MA, Di Chiara G: Differential expression of motivational stimulus properties by dopamine in nucleus accumbens shell versus core and prefrontal cortex. J Neurosci 2002;22:4709-4719.
[PubMed]
11.
Di Chiara G: Nucleus accumbens shell and core dopamine: differential role in behavior and addiction. Behav Brain Res 2002;137:75-114.
[PubMed]
https://doi.org/10.1016%2FS0166-4328%2802%2900286-3
12.
Zahm DS: Functional-anatomical implications of the nucleus accumbens core and shell subterritories. Ann NY Acad Sci 1999;877:113-128.
[PubMed]
https://doi.org/10.1111%2Fj.1749-6632.1999.tb09264.x
13.
Gao G, Wang X, He S, Li W, Wang Q, Liang Q, Zhao Y, Hou F, Chen L, Li A: Clinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery. Stereotact Funct Neurosurg 2003;81:96-104.
[PubMed]
https://doi.org/10.1159%2F000075111
14.
Hutcheson DM, Parkinson JA, Robbins TW, Everitt BJ: The effects of nucleus accumbens core and shell lesions on intravenous heroin self-administration and the acquisition of drug-seeking behaviour under a second-order schedule of heroin reinforcement. Psychopharmacology (Berl) 2001;153:464-472.
[PubMed]
https://doi.org/10.1007%2Fs002130000635
15.
Alderson HL, Parkinson JA, Robbins TW, Everitt BJ: The effects of excitotoxic lesions of the nucleus accumbens core or shell regions on intravenous heroin self-administration in rats. Psychopharmacology (Berl) 2001;153:455-463.
[PubMed]
https://doi.org/10.1007%2Fs002130000634
16.
Kopell BH, Rezai AR: Psychiatric neurosurgery: a historical perspective. Neurosurg Clin N Am 2003;14:181-197.
[PubMed]
https://doi.org/10.1016%2FS1042-3680%2803%2900002-0
17.
Sturm V, Lenartz D, Koulousakis A, Treuer H, Herholz K, Klein JC, Klosterkotter J: The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders. J Chem Neuroanat 2003;26:293-299.
[PubMed]
https://doi.org/10.1016%2Fj.jchemneu.2003.09.003
18.
Gradin VB, Kumar P, Waiter G, Ahearn T, Stickle C, Milders M, Reid I, Hall J, Steele JD: Expected value and prediction error abnormalities in depression and schizophrenia. Brain 2011;134:1751-1764.
[PubMed]
https://doi.org/10.1093%2Fbrain%2Fawr059
19.
Muschamp JW, Van'T VA, Parsegian A, Gallo MS, Chen M, Neve RL, Meloni EG, Carlezon WJ: Activation of CREB in the nucleus accumbens shell produces anhedonia and resistance to extinction of fear in rats. J Neurosci 2011;31:3095-3103.
[PubMed]
https://doi.org/10.1523%2FJNEUROSCI.5973-10.2011
20.
Schlaepfer TE, Cohen MX, Frick C, Kosel M, Brodesser D, Axmacher N, Joe AY, Kreft M, Lenartz D, Sturm V: Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 2008;33:368-377.
[PubMed]
https://doi.org/10.1038%2Fsj.npp.1301408
21.
Pelkonen A, Hiltunen M, Kiianmaa K, Yavich L: Stimulated dopamine overflow and alpha-synuclein expression in the nucleus accumbens core distinguish rats bred for differential ethanol preference. J Neurochem 2010;114:1168-1176.
[PubMed]
22.
Haber SN, Fudge JL, McFarland NR: Striatonigrostriatal pathways in primates form an ascending spiral from the shell to the dorsolateral striatum. J Neurosci 2000;20:2369-2382.
[PubMed]
23.
Haber SN: The primate basal ganglia: parallel and integrative networks. J Chem Neuroanat 2003;26:317-330.
[PubMed]
https://doi.org/10.1016%2Fj.jchemneu.2003.10.003
24.
Lena I, Parrot S, Deschaux O, Muffat-Joly S, Sauvinet V, Renaud B, Suaud-Chagny MF, Gottesmann C: Variations in extracellular levels of dopamine, noradrenaline, glutamate, and aspartate across the sleep-wake cycle in the medial prefrontal cortex and nucleus accumbens of freely moving rats. J Neurosci Res 2005;81:891-899.
[PubMed]
https://doi.org/10.1002%2Fjnr.20602
25.
Rasmussen K: The role of the locus coeruleus and N-methyl-D-aspartic acid (NMDA) and AMPA receptors in opiate withdrawal. Neuropsychopharmacology 1995;13:295-300.
[PubMed]
https://doi.org/10.1016%2F0893-133X%2895%2900082-O
26.
Jenike MA: Neurosurgical treatment of obsessive-compulsive disorder. Br J Psychiatry Suppl 1998:79-90.
[PubMed]
27.
Lippitz BE, Mindus P, Meyerson BA, Kihlstrom L, Lindquist C: Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. Neurosurgery 1999;44:452-458, discussion 458-460.
[PubMed]
https://doi.org/10.1097%2F00006123-199903000-00005
28.
Kondziolka D, Flickinger JC, Hudak R: Results following gamma knife radiosurgical anterior capsulotomies for obsessive compulsive disorder. Neurosurgery 2011;68:28-32.
[PubMed]
https://doi.org/10.1227%2FNEU.0b013e3181fc5c8b
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