JNNP: Laser anterior capsulotomy for the treatment of obsessive-compulsive disorder: lesion size and fiber tractography are related to prognosis

The lifetime prevalence of obsessive-compulsive disorder (OCD) is 1%-3%
.

The incidence is high, and the rates of anxiety, depression, unemployment and social isolation are high

Deep brain stimulation (DBS) has received wide acclaim as an available treatment, but the maximum response does not appear until 3-6 months after surgery

Current capsulotomy techniques include radio frequency (RF) ablation, stereotactic radiosurgery (SRS) and focused ultrasound (FUS)
.

Radiofrequency can relieve OCD immediately and continuously, but the lesions are variable due to unpredictable heat spread

This article was published in "Neurology, Neurosurgery Psychiatry and" ( Journal of Neurology, Neurosurgery & Psychiatry ).

This retrospective case series includes patients who underwent laser anterior capsulotomy for obsessive-compulsive disorder between 2015 and 2020
.

Patients with a follow-up period of less than 3 months were excluded

Under general anesthesia, the head is fixed in a stereotactic frame (CRW; Integra, Plantsboro, New Jersey, USA)
.

The patient underwent intraoperative CT and magnetic resonance T2 and contrast-enhanced T1 MRI serial examinations

Under general anesthesia, the head is fixed in a stereotactic frame (CRW; Integra, Plantsboro, New Jersey, USA)

Laser anterior capsulotomy

According to the five subtype system, patients are classified into obsessive-compulsive disorder subtypes
.

The position of the catheter tip was determined by MRI artifacts

According to the five subtype system, patients are classified into obsessive-compulsive disorder subtypes

Continuous prefrontal thalamic beam scan

18 patients underwent laser anterior capsulotomy
.

The median follow-up time was 6 months (range 3-51 months)

18 patients underwent laser anterior capsulotomy
.
The median follow-up time was 6 months (range 3-51 months)
.
18 patients underwent laser anterior capsulotomy
.
The median follow-up time was 6 months (range 3-51 months)
.

Anterior capsulotomy has been performed using a variety of techniques since the 1940s
.
The response rate of mechanical incision is low, and the risk of intracerebral hemorrhage is relatively high
.
Radio frequency can produce long-term stable effect immediately
.
Due to the inherent limitations of energy delivery in the two methods, the Y-BOCS score gradually improved after SRS and FUS treatment
.
And RF, as the SRS and FUS different, appear significantly improved immediately after LIT
.
Although perioperative factors such as recent anesthesia may confuse the assessment of immediate treatment response, the significant improvement in Y-BOCS scores observed 1-2 months after surgery confirms this finding
.
The safety of anterior capsulotomy has been fully proven
.
The total publication rate of bleeding (1.
8%) and hemiplegia (0.
8%) is very low
.
According to reports, 13% of patients gained weight
.
9% of patients had a second operation due to a small lesion
.
In this case group, one patient had asymptomatic intracerebral hemorrhage; no focal neurological deficit was observed; one patient needed another operation
.

Anterior capsulotomy has been performed using a variety of techniques since the 1940s
.
The response rate of mechanical incision is low, and the risk of intracerebral hemorrhage is relatively high
.
Radio frequency can produce long-term stable effect immediately
.
Due to the inherent limitations of energy delivery in the two methods, the Y-BOCS score gradually improved after SRS and FUS treatment
.
Anterior capsulotomy has been performed using a variety of techniques since the 1940s
.
The response rate of mechanical incision is low, and the risk of intracerebral hemorrhage is relatively high
.
Radio frequency can produce long-term stable effect immediately
.
Due to the inherent limitations of energy delivery in the two methods, the Y-BOCS score gradually improved after SRS and FUS treatment
.

In short, laser anterior capsulotomy can immediately improve the severity of obsessive-compulsive disorder symptoms
.

Satzer  D ,  Mahavadi  A ,  Lacy  M Satzer  DSatzer Mahavadi  AMahavadi Lacy  MLacy, et alInterstitial laser anterior capsulotomy for obsessive--compulsive disorder: lesion size and tractography correlate with outcomeJournal of Neurology, Neurosurgery & Psychiatry  Published Online First:  29 October 2021.
 Published Online First: doi:  10.
1136/jnnp-2021-327730doi:

 

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