Gamma ventral capsulotomy for treatment of resistant obsessive-compulsive disorder: a structural MRI pilot prospective study.
OBJECTIVE
The purpose of this study was to investigate regional structural abnormalities in the brains of five patients with refractory obsessive-compulsive disorder (OCD) submitted to gamma ventral capsulotomy.


METHODS
We acquired morphometric magnetic resonance imaging (MRI) data before and after 1 year of radiosurgery using a 1.5-T MRI scanner. Images were spatially normalized and segmented using optimized voxel-based morphometry (VBM) methods. Voxelwise statistical comparisons between pre- and post-surgery MRI scans were performed using a general linear model. Findings in regions predicted a priori to show volumetric changes (orbitofrontal cortex, anterior cingulate gyrus, basal ganglia and thalamus) were reported as significant if surpassing a statistical threshold of p<0.001 (uncorrected for multiple comparisons).


RESULTS
We detected a significant regional postoperative increase in gray matter volume in the right inferior frontal gyri (Brodmann area 47, BA47) when comparing all patients pre and postoperatively.


CONCLUSIONS
Our results support the current theory of frontal-striatal-thalamic-cortical (FSTC) circuitry involvement in OCD pathogenesis. Gamma ventral capsulotomy is associated with neurobiological changes in the inferior orbitofrontal cortex in refractory OCD patients.
Department of Psychiatry, University of São Paulo Medical School (FMUSP), São Paulo, SP, Brazil. janainaphilippi@gmail.com
Janaína Philippi
JP
Cecconi
Antônio Carlos
AC
Lopes
Fábio Luis de Souza
FL
Duran
Luciana Cristina
LC
Santos
Marcelo Queiroz
MQ
Hoexter
André Felix
AF
Gentil
Miguel Montes
MM
Canteras
Claudio Campi de
CC
Castro
George
G
Norén
Benjamin D
BD
Greenberg
Scott L
SL
Rauch
Geraldo F
GF
Busatto
Eurípedes Constantino
EC
Miguel
D000328:Adult; D001921:Brain / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000473:pathology* / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*