Fig. 5
From: Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder
Three-dimensional reconstruction with magnetic resonance diffusion tensor imaging and tractography, showing fibers crossing the internal capsule. Coronal (a), sagittal (b) and axial (c) fluid-attenuated inversion recovery sequences, fused to tractography, demonstrating the relationship of the fibers of the anterior limb of the internal capsule (ALIC) passing through the capsulotomy target (thin, blue, intersecting lines, small arrows). a Numbers in white correspond to the order of the fibers: 1 lateral orbitofrontal cortex; 2 central orbitofrontal cortex; 3 medial orbitofrontal cortex; 4 ventromedial prefrontal cortex. b The large open arrow indicates connections between the cingulate, inferior orbitofrontal, central orbitofrontal, medial orbitofrontal, and ventromedial prefrontal cortex and the thalamus. c The fibers, numbered 3 in a, b, and c, are the medial orbitofrontal cortical fibers reaching the thalamus (large open arrow). d Three-dimensional reconstruction showing an overview of all fibers passing through the ALIC. The large open arrow indicates the medial orbitofrontal cortical fibers reaching the thalamus. The double arrow represents the fibers affected by capsulotomy. The curved arrow indicates the cingulate, inferior orbitofrontal, central orbitofrontal, medial orbitofrontal, and ventromedial prefrontal cortex connections with the brainstem (forebrain bundle), a reinforcement system important in OCD. For more information refer to Lemaire et al. [120]
