title: Results following gamma knife radiosurgical anterior capsulotomies for obsessive compulsive disorder.
abstract: BACKGROUND
  Obsessive compulsive disorder (OCD), in its severe form, can cause tremendous disability for affected patients.
  
  
  OBJECTIVE
  To evaluate the results following bilateral radiosurgical anterior capsulotomy for severe medically refractory OCD.
  
  
  METHODS
  We performed gamma knife anterior capsulotomy (GKAC) on 3 patients with extreme, medically intractable OCD. According to our protocol, all patients were evaluated by at least 2 psychiatrists who recommended surgery. The patient had to request the procedure, and had to have severe OCD according to the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patient ages were 37, 55, and 40 years, and pre-radiosurgery YBOCS scores were 34/40, 39/40, and 39/40. Bilateral lesions were created with 2 4-mm isocenters to create an oval volume in the ventral internal capsule at the putaminal midpoint. A maximum dose of 140 or 150 Gy was used.
  
  
  RESULTS
  There was no morbidity after the procedure, and all patients returned immediately to baseline function. All patients noted significant functional improvements, and reduction in OCD behavior. Follow-up was at 55, 42, and 28 months. The first patient reduced her YBOCS score from 34 to 24. One patient with compulsive skin picking and an open wound had later healing of the chronic wound and a reduction in the YBOCS score from 39 to 8. At 28 months, the third patient is living and working independently, and her YBOCS score is 18.
  
  
  CONCLUSIONS
  Within a strict protocol, gamma knife radiosurgery provided improvement of OCD behavior with no adverse effects. This technique should be evaluated further in patients with severe and disabling behavioral disorders.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. kondziolkads@upmc.edu
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: Robert
authors.initials: R
authors.lastname: Hudak
mesh_terms: D000328:Adult; D001921:Brain / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000601:surgery*; D016634:Radiosurgery