Renaissance for anterior capsulotomy for obsessive-compulsive disorder?

How a new neurosurgical tool may revive an old, efficient but neglected, procedure

Satzer et al1 report on 18 patients with severe obsessive–compulsive disorder (OCD) who underwent anterior capsulotomy using MRI-guided laser interstitial thermal therapy (LITT). At a mean of 6 months (range: 3–51 months), the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) scores improved by 46%, and 61% of patients were considered responders (ie, with >35% amelioration of Y-BOCS scores). Neuropsychological tests and functional status showed improvement. Side effects, mostly transient apathy, were mild. Greater improvement was seen with larger lesions, but tractography and connectivity data did not show a clear relationship between the selectivity of lesioning of the ‘various and variable’ prefrontal cortex projections and the degree of improvement.

In this era of frenetic activity around deep brain stimulation (DBS) for OCD, it is refreshing to read a scientific report on a straightforward ablative procedure, introduced in the early 1950s,…

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