Gamma Ventral Capsulotomy in Intractable Obsessive-Compulsive Disorder.

Area of Science:

• Neurosurgery
• Radiosurgery
• Psychiatry

Background:

• Obsessive-compulsive disorder (OCD) can be debilitating and treatment-resistant.
• Existing treatments for OCD have limitations for some patients.
• Neurosurgical interventions target specific brain circuits implicated in OCD.

Purpose of the Study:

• To evaluate the safety and efficacy of ventral gamma capsulotomy for intractable OCD.
• To assess long-term outcomes of this radiosurgical procedure.

Main Methods:

• Fifty-five patients with treatment-refractory OCD underwent bilateral ventral anterior limb of the internal capsule lesions using Leksell Gamma Knife.
• Patients were prospectively followed for 3 years with comprehensive assessments.
• Structural neuroimaging was used to monitor for adverse effects.

Main Results:

• 56% of patients showed a significant improvement (≥35%) in OCD symptoms.
• Improvements were observed in depression, anxiety, quality of life, and global functioning.
• The procedure was well-tolerated; 9% experienced transient edema, and 5% developed cysts, with one case of radionecrosis.

Conclusions:

• Gamma Knife ventral capsulotomy is an effective radiosurgical option for many patients with treatment-refractory OCD.
• While generally safe, potential long-term risks include cyst formation and, rarely, permanent neurological sequelae.