Bilateral orbitomedial leucotomy for obsessive-compulsive disorder: a single-case study using positron emission tomography.
OBJECTIVE
The objective of this report is to correlate the clinical outcome of neurosurgery for obsessive-compulsive disorder (OCD) with regional cerebral glucose metabolic changes.


METHODS
The patient was a 37-year-old female patient with severe and intractable OCD.


METHODS
The patient was treated with bilateral stereotactic lesions in the frontal white matter superior to the orbito-medial cortex.


RESULTS
She had a remarkable improvement in her obsessive-compulsive symptoms, which was sustained up to 3 years of follow up. A positron emission tomography (PET) scan performed 18 days after surgery demonstrated an obvious reduction of metabolism in the caudate head, anterior cingulate and orbital, medial and lateral prefrontal cortices and the thalamus. At 1 year postsurgery, metabolic rate was still reduced in the anterior cingulate gyrus, caudate and thalamus compared with preoperative baseline. The patient demonstrated no long-term cognitive effects of the surgery.


CONCLUSIONS
This case supports some of the cortical-subcortical circuit dysfunction models of OCD and argues for the further evaluation of neurosurgery for the treatment of a severe and intractable disorder.
Sachdev
P
P
Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, New South Wales 2031, Australia. p.sachdev@unsw.edu.au
Trollor
J
J
Walker
A
A
Wen
W
W
Fulham
M
M
Smith
J S
JS
Matheson
J
J
D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D011612:Psychosurgery / Q000379:methods*; D019275:Radiopharmaceuticals; D016634:Radiosurgery / Q000379:methods; D012074:Remission Induction; D012720:Severity of Illness Index; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18