Stereotactic ablation surgery for treatment-resistant obsessive-compulsive disorder: Technical evolution, clinical...

Obsessive-compulsive disorder (OCD) is a common and debilitating psychiatric illness. Treatment-resistant OCD remains a major clinical challenge, as a substantial proportion of patients fail to respond adequately to pharmacological or psychotherapeutic interventions. Stereotactic ablation surgery, an established neurosurgical approach, alleviates symptoms by precisely disrupting hyperactive neural circuits implicated in OCD. Despite its demonstrated efficacy, this intervention has generated ongoing ethical debate because of its invasive and irreversible nature. Nevertheless, a careful examination of its theoretical foundations and clinical outcomes can yield valuable insights for the management of severe OCD. This review systematically traces the technological evolution of stereotactic ablation, including radiofrequency ablation, laser interstitial thermal therapy, radiosurgery, and focused ultrasound. In addition, it provides a comprehensive evaluation of the underlying mechanisms, therapeutic efficacy, and safety profiles associated with these techniques. Ultimately, this work aims to offer both a conceptual framework and a clinically relevant reference to inform the future development of physical interventions with improved safety and potentially enhanced therapeutic effectiveness.