Treatment of chronic obsessive compulsive states with stereotactic anterior capsulotomy or cingulotomy

Abstract

A neuropsychological model on how to evaluate patients subjected to stereotactic psychosurgery is presented. Four patients with chronic obsessive compulsive neurosis were randomly assigned to either stereotactic anterior capsulotomy or cingulotomy, and assessed pre-, peri-, and postoperatively according to this model. The best immediate and long-term follow-up results in reducing obsessional symptoms were obtained in the two capsulotomized patients. Psychosurgery should only be performed by a multidisciplinary team of specialists, with objective evaluation, adequate information on patients, and reliable test instruments.

Visuospatial Memory Improvement after Gamma Ventral Capsulotomy in Treatment Refractory Obsessive–Compulsive Disorder Patients

“…Alternatively, it is also possible that symptom improvements, together with other aspects that interfere with patients' motivation or concentration, had a role in the post-operative neuropsychological evaluation; and (3) since the amelioration of neuropsychological functions in our patients submitted to surgery probably did not occur by chance, the third assumption possible interpretation seems to better explain our results. The interruption of hyperfunctional frontal-striatal circuits involved in the pathophysiology of OCD (Fodstad et al, 1982;Kondziolka et al, 2011;Lopes et al, 2009;Rück et al, 2008) could directly or indirectly lead to restorative changes in prefrontal cortex and therefore VSM pathways, restoring previous dysfunctional VSM circuits (Curtis, 2006;Figee et al, 2013). Distinct cognitive domains assessed by VSM tests, including visual attention, spatial perception, visuomotor skills, and visuospatial organization, could have contributed to our overall findings.…”

“…Anterior capsulotomy (AC), a neurosurgical intervention that acts by disrupting white matter tracts of the corticostriatal-pallido-thalamic-cortical circuitry (hypothesized to be dysfunctional in OCD), has been successfully employed in carefully selected cases Rauch et al, 1994;Rück et al, 2008). Specifically, AC by thermocoagulation and gamma-knife radiosurgery (Gamma ventral capsulotomy, GVC) have demonstrated comparable efficacy in reducing obsessive-compulsive symptoms (OCS), although there are no studies directly comparing these techniques (Fodstad et al, 1982;Kondziolka et al, 2011;Lopes et al, 2004Lopes et al, , 2009Miguel et al, 2004;Rück et al, 2008). However, the safety profile of both surgical methods remain less clear, in particular regarding post-operative cognitive performance, with only a few studies investigating neuropsychological outcomes (Csigó et al, 2010;Fodstad et al, 1982;Nyman and Andreewitch, 2001;Nyman and Mindus, 1995;Rück et al, 2008;Taub et al, 2009).…”

Review of Long-term Results of Stereotactic Psychosurgery.

“…4,5) The basolateral circuit involves the anterior temporal lobe, amygdala, dorsomedial thalamic nucleus, and orbitofrontal cortex. 7) The anterior cingulum was first suggested as a psychosurgical target in 1947, 6,23) on the basis of evidence that stimulation of the anterior cingulum in monkeys produced autonomic responses of a type associated with emotion and that lesions in this region resulted in less fearful and aggressive animals. Ventriculography has more recently been replaced with MR imaging-guided stereotactic techniques.…”

Long-Term Follow-Up of MRI-Guided Bilateral Anterior Capsulotomy in Patients with Refractory Schizophrenia

“…Many modern MRI-guided procedures were used to treat mental diseases, such as frontal lobotomy, anterior cingulotomy, subcaudate tractotomy, limbic leukotomy and anterior capsulotomy [23,24,25]. Following a variety of studies, a general conclusion was reached that significant improvements are observed in approximately 70% of patients with refractory obsessive and compulsive disease (OCD) who undergo capsulotomy [26,27,28,29]. The success of capsulotomy achieved in OCD stimulated researchers to extend its application to other mental diseases [30,31,32].…”