Long-term Clinical Outcomes of Gamma Knife Ventral Capsulotomy in Refractory Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a common psychiatric disorder that can cause profound socio-economic impediments to patients and their families. Gamma knife radiosurgery (GKRS) ventral capsulotomy has been attempted in refractory OCD; however, the outcomes are far from established.

Twelve patients with chronic, severe OCD refractory to pharmacotherapy and cognitive behavior therapy underwent GKRS capsulotomy between 2012 and 2024. We conducted a retrospective chart review of ten patients with > 1 year of follow-up. The patients underwent structured assessment, including Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Global Assessment of Functioning (GAF).

The cohort comprised four males and six females with a mean age of 36.7 ± 13.5 years and duration of illness of 16.4 ± 7.5 years at the time of surgery. The patients were followed up for a mean of 5.5 ± 2.83 years. Six of the ten patients (60%) satisfied the criteria for response during follow-up. Wilcoxon signed-rank test found a significant reduction in Y-BOCS score (W = 36, P = 0.014) and improvement in GAF scores (W = 0, P = 0.014) at the last follow-up. There was a variability in the onset (1-5 years) and extent of improvement (0-82.3%). Age at surgery, duration of illness, and baseline Y-BOCS scores were not correlated with symptom change at last follow-up. One of the patients developed seizures at follow-up.

GKRS ventral capsulotomy appears to be a promising and relatively safe treatment for refractory OCD, with improvement becoming apparent months following surgery.