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Multicenter Study
An International Radiosurgery Research Foundation Multicenter Retrospective Study of Gamma Ventral Capsulotomy for Obsessive Compulsive Disorder.
- Amitabh Gupta, Matthew J Shepard, Zhiyuan Xu, Tanmoy Maiti, Nuria Martinez-Moreno, Joshua Silverman, Christian Iorio-Morin, Roberto Martinez-Alvarez, Gene Barnett, David Mathieu, Hamid Borghei-Razavi, Douglas Kondziolka, and Jason P Sheehan.
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
- Neurosurgery. 2019 Dec 1; 85 (6): 808-816.
BackgroundObsessive compulsive disorder (OCD) across its full spectrum of severity is a psychiatric illness affecting ∼2% to 3% of the general population and results in significant functional impairment. There are few large patient series regarding Gamma ventral capsulotomy (GVC).ObjectiveTo evaluate clinical outcomes of severe medically refractory OCD treated with GVC.MethodsThis is an international, multicenter, retrospective cohort study. Forty patients with pre-GVC Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores ≥ 24 (indicating severe OCD) were included. GVC was performed with 1 or 2 isocenters with a median maximum dose of 135 Gy (range, 120-180 Gy). Patients were deemed "responders" to GVC if there was ≥35% reduction of follow-up Y-BOCS scores, and considered in remission if their Y-BOCS scores were ≤16. The median follow-up was 36 mo (range, 6-96 mo).ResultsThe median pre-SRS Y-BOCS score was 35 (range, 24-40). Eighteen patients (45%) were considered "responders," and 16 (40%) of them were in remission at their last follow-up. Nineteen patients (47.5%) remained stable with Y-BOCS of 33 (range, 26-36) following GVC, whereas 3 patients (7.5%) experienced worsening in Y-BOCS scores. Patients treated with 2 isocenters were more likely to have improvement in Y-BOCS score at 3 and 5 yr (P < .0005). Ten patients (25%) experienced post-GVC mood disturbance and neurological complications in 3 patients (7.5%). One patient developed radiation necrosis with edema that improved with steroids.ConclusionGVC serves as a reasonable treatment strategy for severe medical refractory OCD. Patients treated with 2 isocenters were more likely to have substantial improvement in OCD.Copyright © 2018 by the Congress of Neurological Surgeons.
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