title: Beneficial effect of subsequent lesion procedures after nonresponse to initial cingulotomy for severe, treatment-refractory obsessive-compulsive disorder.
abstract: BACKGROUND
  Anterior cingulotomy (AC) can be an effective therapy for patients with severe obsessive-compulsive disorder who are refractory to traditional medical therapy. For patients who do not respond to AC, the benefit of additional lesion procedures vs continued medical management remains unknown.
  
  
  OBJECTIVE
  To determine whether a second lesion procedure is beneficial after unsuccessful initial AC.
  
  
  METHODS
  In this retrospective cohort study, we reviewed the records of 31 patients who were nonresponders to initial AC. Full response was defined as at least a 35% decrease and partial response as a 25% to 34% decrease in Yale-Brown Obsessive-Compulsive Scale scores. Yale-Brown Obsessive-Compulsive Scale change was compared between patients who underwent additional surgery and those treated nonsurgically. In addition, for patients who underwent additional surgery, we compared the benefit of subcaudate tractotomy with repeat AC (extension of the initial lesion) as the second procedure.
  
  
  RESULTS
  Nineteen patients underwent a second surgery and 12 patients continued nonsurgical therapy. Fifty-three percent of patients who received additional surgery were full responders and 21% were partial responders at the most recent follow-up compared with 17% full responders and 25% partial responders among those who continued conventional therapy (P = .02). Of the patients who underwent an additional surgery, there were 64% full and 9% partial responders in the subcaudate tractotomy group compared with 38% full and 38% partial responders in the repeat AC group (P = .04).
  
  
  CONCLUSIONS
  Second lesion surgery can be a safe and effective therapy for patients who do not respond to initial AC. Subcaudate tractotomy may confer a higher response rate than repeat cingulotomy.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Bourne
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Sheth
authors.forename: Jonathan
authors.initials: J
authors.lastname: Neal
authors.forename: Christian
authors.initials: C
authors.lastname: Strong
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Mian
authors.forename: G Rees
authors.initials: GR
authors.lastname: Cosgrove
authors.forename: Emad N
authors.initials: EN
authors.lastname: Eskandar
authors.forename: Darin D
authors.initials: DD
authors.lastname: Dougherty
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D006179:Gyrus Cinguli / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000601:surgery*; D011183:Postoperative Complications; D011569:Psychiatric Status Rating Scales; D011612:Psychosurgery / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome