Bilateral Anterior Capsulotomy for Treatment-Resistant Obsessive-Compulsive Disorder.

IF 1.9 4区医学 Q3 NEUROIMAGING Stereotactic and Functional Neurosurgery Pub Date : 2024-08-23 DOI:10.1159/000540503

Trevor Hurwitz, Geoffrey Ching, Nicholas Mark Bogod, Christopher R Honey

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Abstract

Introduction: Ablative surgery is an intervention of last resort for treatment-resistant obsessive-compulsive disorder (TROCD). Our center has been using bilateral anterior capsulotomy (BAC) for the past 20 years for patients eligible for limbic surgery. This report details our experience with BAC for TROCD.

Method: Five patients with OCD met eligibility criteria for BAC. Entry protocols were complex and took around 6 months to complete. Stereotactic radiofrequency was used to produce the capsulotomies. Lesion length varied between 5.7 and 16.9 mm in the coronal plane. Patients were followed between 4 and 20 years.

Results: All 5 patients (100%) were responders as defined by the widely accepted criteria of a reduction of ≥35% in Yale-Brown Obsessive Compulsive Scale (YBOCS) score at 18-month follow-up. Four patients remained responders at the 48 months. One patient was lost to follow-up. Responder status when viewed from the perspective of the YBOCS was sustained over the 4- to 20-year follow-up with one relapse 19 years postsurgery when medications were discontinued. Real-world psychiatric outcomes were different as other vulnerabilities surfaced illustrating the multifactorial determinants of mental health. No patient had any significant long-term neurocognitive or physical side effects.

Conclusion: BAC should remain an option of last resort for patients with severe OCD who remain unresponsive to all other interventions.

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治疗难治性强迫症的双侧前囊切除术

导言：消融手术是治疗难治性强迫症（TROCD）的最后手段。在过去的 20 年中，我们中心一直在为符合边缘手术条件的患者实施双侧前囊切开术（BAC）。本报告详细介绍了我们使用 BAC 治疗 TROCD 的经验：方法：五名强迫症患者符合 BAC 的资格标准。入组方案非常复杂，大约需要 6 个月才能完成。采用立体定向射频技术进行囊肿切开术。在冠状面上，病变长度在 5.7 至 16.9 毫米之间。对患者进行了4至20年的随访：所有 5 名患者（100%）均有反应，其标准是在 18 个月的随访中，耶鲁-布朗强迫症量表（YBOCS）评分降低≥35%，这一标准已被广泛接受。四名患者在 48 个月后仍有反应。一名患者失去了随访机会。从 YBOCS 的角度来看，有反应者的状态在 4 到 20 年的随访中一直保持不变，只有一名患者在术后 19 年停药后复发。现实世界中的精神疾病治疗结果却有所不同，因为其他易感因素的出现说明了精神健康的多因素决定因素。没有患者出现任何明显的长期神经认知或身体副作用：BAC仍应是对所有其他干预措施均无反应的严重强迫症患者的最后选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stereotactic and Functional Neurosurgery 医学-神经成像

CiteScore

3.80

自引率

0.00%

发文量

审稿时长

3 months

期刊介绍： ''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.