Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder

Area of Science:

• Neurosurgery
• Radiosurgery
• Psychiatry

Background:

• Stereotactic neurosurgery has treated severe, refractory obsessive-compulsive disorder (OCD) for over 50 years.
• Improved efficacy is linked to refined patient selection and understanding of OCD neuroanatomy.
• Gamma knife capsulotomy (GKC) emerged as a stereotactic radiosurgical technique for OCD.

Purpose of the Study:

• To review the history and evolution of Gamma Knife Capsulotomy (GKC) for obsessive-compulsive disorder (OCD).
• To systematically review existing literature and provide a narrative account of GKC's development.
• To discuss future directions for GKC therapy in refractory OCD.

Main Methods:

• Systematic review of existing literature on GKC for OCD.
• Narrative account of the procedural evolution and influencing factors.
• Analysis of clinical efficacy, adverse events, and neuropsychological outcomes.

Main Results:

• GKC has evolved with decreased adverse events and sustained favorable response rates (50-67%) at experienced centers.
• Symptom reduction may stem from direct neural modulation and synergistic effects with other therapies.
• Neuropsychological assessments indicate no cognitive impairment, with potential improvements in some domains.

Conclusions:

• GKC, especially gamma ventral capsulotomy, remains a reliable treatment for selected refractory OCD cases.
• Future progress requires optimized trial design, biophysical modeling for targeting/dosing, and advanced imaging for response prediction.
• Continued research is essential for refining GKC therapy and understanding its mechanisms.