Bilateral Anterior Capsulotomy for Treatment-Resistant Obsessive-Compulsive Disorder.

Ablative surgery is an intervention of last resort for treatment-resistant obsessive-compulsive disorder (TROCD). Our center has been using bilateral anterior capsulotomy (BAC) for the past 20 years for patients eligible for limbic surgery. This report details our experience with BAC for TROCD. Five patients with OCD met eligibility criteria for BAC. Entry protocols were complex and took around 6 months to complete. Stereotactic radiofrequency was used to produce the capsulotomies. Lesion length varied between 5.7 and 16.9 mm in the coronal plane. Patients were followed between 4 and 20 years. All 5 patients (100%) were responders as defined by the widely accepted criteria of a reduction of ≥35% in Yale-Brown Obsessive Compulsive Scale (YBOCS) score at 18-month follow-up. Four patients remained responders at the 48 months. One patient was lost to follow-up. Responder status when viewed from the perspective of the YBOCS was sustained over the 4- to 20-year follow-up with one relapse 19 years postsurgery when medications were discontinued. Real-world psychiatric outcomes were different as other vulnerabilities surfaced illustrating the multifactorial determinants of mental health. No patient had any significant long-term neurocognitive or physical side effects. BAC should remain an option of last resort for patients with severe OCD who remain unresponsive to all other interventions.

Hurwitz T ，Ching G ，Bogod NM ，Honey CR ... -  《-》

Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up.

D'Astous M ，Cottin S ，Roy M ，Picard C ，Cantin L ... -  《-》

Stereotactic treatment of refractory obsessive compulsive disorder by bilateral capsulotomy with 3 years follow-up.

Liu K ，Zhang H ，Liu C ，Guan Y ，Lang L ，Cheng Y ，Sun B ，Wang H ，Zuo C ，Pan L ，Xu H ，Li S ，Shi L ，Qian J ，Yang Y ... -  《JOURNAL OF CLINICAL NEUROSCIENCE》

Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies.

Brown LT ，Mikell CB ，Youngerman BE ，Zhang Y ，McKhann GM 2nd ，Sheth SA ... -  《-》

Magnetic Resonance Imaging-Guided Laser Thermal Ventral Capsulotomy for Intractable Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is a disabling condition characterized by intrusive thoughts and repetitive behaviors. A subset of individuals have severe, treatment-resistant illness and are nonresponsive to medication or behavioral therapies. Without response to conventional therapeutic options, surgical intervention becomes an appropriate consideration. To report clinical outcomes and the safety profile of bilateral ventral anterior capsulotomy for OCD using magnetic resonance (MR)-guided laser interstitial thermal therapy (LITT) in 10 patients followed for 6 to 24 mo. A total of 10 patients underwent LITT for severe OCD; 1 patient withdrew prior to follow-up. LITT is a minimally invasive ablative technique performed with precise targeting and use of thermography under MR guidance. Lesions of the ventral anterior limb of the internal capsule by other techniques have been shown to be efficacious in prior studies. A total of 7 of the 9 patients were considered full responders (77.8%; Yale-Brown Obsessive-Compulsive Scale change ≥35%). Adverse effects included transient apathy/amotivation postsurgery (2 patients). One patient had a small tract hemorrhage where the laser fiber traversed the cerebral cortex as well as persistent insomnia postsurgery. One individual died after a drug overdose 7 mo postsurgery, which was judged unrelated to the surgery. LITT ventral capsulotomy was generally well tolerated, with promising evidence of effectiveness in the largest such series to date. Results were comparable to those after gamma knife ventral capsulotomy, as well as ventral anterior limb deep brain stimulation.

McLaughlin NCR ，Lauro PM ，Patrick MT ，Pucci FG ，Barrios-Anderson A ，Greenberg BD ，Rasmussen SA ，Asaad WF ... -  《-》