BACKGROUND Despite the development of effective pharmacologic and cognitive behavioral treatments for obsessive-compulsive disorder (OCD), some patients continue to be treatment-refractory and severely impaired. Fiber tracts connecting orbitofrontal and dorsal anterior cingulate cortex with subcortical nuclei have been the target of neurosurgical lesions as well as deep brain stimulation in these patients. We report on the safety and efficacy of ventral gamma capsulotomy for patients with intractable OCD. METHODS Fifty-five patients with severely disabling, treatment-refractory OCD received bilateral lesions in the ventral portion of the anterior limb of the internal capsule over a 20-year period using the Leksell Gamma Knife. The patients were prospectively followed over 3 years with psychiatric, neurologic, and neuropsychological assessments of safety and efficacy, as well as structural neuroimaging. RESULTS Thirty-one of 55 patients (56%) had an improvement in the primary efficacy measure, the Yale-Brown Obsessive Compulsive Scale, of ≥35% over the 3-year follow-up period. Patients had significant improvements in depression, anxiety, quality of life, and global functioning. Patients tolerated the procedure well without significant acute adverse events. Five patients (9%) developed transient edema that required short courses of dexamethasone. Three patients (5%) developed cysts at long-term follow-up, 1 of whom developed radionecrosis resulting in an ongoing minimally conscious state. CONCLUSIONS Gamma Knife ventral capsulotomy is an effective radiosurgical procedure for many treatment-refractory OCD patients. A minority of patients developed cysts at long-term follow-up, 1 of whom had permanent neurological sequelae.

中文翻译：

---

难治性强迫症的伽马腹侧囊切开术

背景尽管针对强迫症 (OCD) 开发了有效的药物和认知行为疗法，但一些患者仍然难以治疗且严重受损。连接眶额和背侧前扣带皮层与皮质下核的纤维束已成为这些患者神经外科病变和深部脑刺激的目标。我们报告腹侧伽马囊切开术治疗顽固性强迫症患者的安全性和有效性。方法 55 名患有严重致残、难治性强迫症的患者在内囊前肢的腹侧部分使用 Leksell 伽玛刀在 20 年的时间内接受了双侧病变。对患者进行了 3 年以上的前瞻性随访，包括精神病学、神经学、安全性和有效性的神经心理学评估，以及结构神经影像学。结果 在 3 年的随访期间，55 名患者中有 31 名 (56%) 的主要疗效指标（耶鲁-布朗强迫症量表）改善 ≥ 35%。患者的抑郁、焦虑、生活质量和整体功能都有显着改善。患者对手术的耐受性良好，没有明显的急性不良事件。5 名患者 (9%) 出现一过性水肿，需要短期服用地塞米松。三名患者 (5%) 在长期随访中出现囊肿，其中 1 名出现放射性坏死，导致持续的最低意识状态。结论伽玛刀腹侧囊切开术对于许多难治性强迫症患者来说是一种有效的放射外科手术。