Stereotactic Radiosurgery Capsulotomy for Intractable Severe Obsessive-Compulsive Disorder: A Systematic Review,...

Area of Science:

• Neurosurgery
• Psychiatry
• Radiology

Background:

• Obsessive-compulsive disorder (OCD) affects 1-3% of the population, with 10% being refractory to standard treatments.
• Stereotactic radiosurgery capsulotomy (SRSC) is an emerging therapeutic option for severe, treatment-resistant OCD cases.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy and safety of SRSC for OCD treatment.
• To provide clinical practice guidelines for SRSC in refractory OCD.

Main Methods:

• Searched PubMed, Embase, Web of Science, and Scopus for studies with ≥3 SRSC-treated patients and ≥6 months follow-up.
• Analyzed primary outcomes: Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction, remission (Y-BOCS ≤16), and complete response (≥35% Y-BOCS reduction).
• Conducted meta-analyses using R software to assess efficacy, safety, and prognostic factors.

Main Results:

• Seventeen studies (254 patients) showed SRSC reduced Y-BOCS scores by 46.52% (p<0.001).
• Complete response and remission rates were 56.48% and 49.30%, respectively, with significant global functioning improvement.
• Adverse events were generally mild (e.g., weight change, transient mood disturbances), with rare serious complications.

Conclusions:

• SRSC demonstrates significant efficacy in alleviating OCD symptoms in treatment-refractory patients.
• The procedure has an acceptable safety profile, supporting its use in selected cases.
• Consensus-based guidelines are provided to facilitate clinical implementation.