Skip to main content
SpringerLink
Log in

Obsessive-Compulsive Disorder: Lesions

  • Chapter
  • First Online:
Stereotactic and Functional Neurosurgery

Abstract

Neuroablative or lesion procedures represent some of the earliest surgical techniques used to treat psychiatric illness. Obsessive-compulsive disorder (OCD) remains one of the psychiatric illnesses most commonly treated with neurosurgery. In the past 50 years, more precise ablative techniques combined with careful patient selection and improved perioperative care have proven efficacious in treating patients with medically refractory OCD. Ablative techniques and functional imaging studies have also begun to uncover the neurobiological mechanisms underlying OCD and have identified cortico-striato-thalamic-cortical (CSTC) neurocircuitry implicated in OCD pathology. The most commonly reported procedures that have been used in modern psychiatric neurosurgical practice for OCD aim to target this pathologic circuitry and include the subcaudate tractotomy, cingulotomy, limbic leucotomy, and capsulotomy. Notably, lesion procedures exhibit similar efficacy to deep brain stimulation (DBS) in treating OCD and in some cases may be a more practical and preferred surgical treatment modality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ACC:

Anterior cingulate cortex

CSTC:

Cortico-striato-thalamo-cortical

DBS:

Deep brain stimulation

ERP:

Exposure and response prevention

GKRS:

Gamma Knife radiosurgery

GVC:

Gamma Knife ventral capsulotomy

MDD:

Major depressive disorder

MRI:

Magnetic resonance imaging

OCD:

Obsessive-compulsive disorder

OFC:

Orbitofrontal cortex

SSRI:

Selective serotonin reuptake inhibitor

YBOCS:

Yale-Brown Obsessive Compulsive Scale

References

  1. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15:53–63.

    Article  CAS  PubMed  Google Scholar 

  2. Rasmussen SA, Eisen JL. Treatment strategies for chronic and refractory obsessive-compulsive disorder. J Clin Psychiatry. 1997;58 Suppl 13:9–13.

    Google Scholar 

  3. Rasmussen SA, Noren G, Greenberg BD, Marsland R, McLaughlin NC, Malloy PJ, et al. Gamma ventral capsulotomy in intractable obsessive-compulsive disorder. Biol Psychiatry. 2018;84:355.

    Article  PubMed  Google Scholar 

  4. de Haan S, Rietveld E, Stokhof M, Denys D. The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model. Front Hum Neurosci. 2013;7:653.

    PubMed  PubMed Central  Google Scholar 

  5. de Haan S, Rietveld E, Stokhof M, Denys D. Effects of deep brain stimulation on the lived experience of obsessive-compulsive disorder patients: in-depth interviews with 18 patients. PLoS One. 2015;10:e0135524.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Kohl S, Schönherr DM, Luigjes J, Denys D, Mueller UJ, Lenartz D, et al. Deep brain stimulation for treatment-refractory obsessive compulsive disorder: a systematic review. BMC Psychiatry. 2014;14:214.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Heyman I, Mataix-Cols D, Fineberg NA. Obsessive-compulsive disorder. BMJ. 2006;333(7565):424–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Greenberg BD, Price LH, Rauch SL, Friehs G, Noren G, Malone D, et al. Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues. Neurosurg Clin N Am. 2003;14:199–212.

    Article  PubMed  Google Scholar 

  9. Ferrão YA, Shavitt RG, Bedin NR, de Mathis ME, Carlos Lopes A, Fontenelle LF, et al. Clinical features associated to refractory obsessive–compulsive disorder. J Affect Disord. 2006;94:199–209.

    Article  PubMed  Google Scholar 

  10. Cosgrove GR, Rauch SL. Psychosurgery – Neurosurgical Service – Massachusetts General Hospital. Neurosurgery Massachusetts General Hospital. 2005.

    Google Scholar 

  11. McLaughlin NCR, Stewart C, Greenberg BD. Deep brain stimulation for obsessive-compulsive disorder and major depressive disorder. In: Psychiatric neurotherapeutics. New York: Springer New York; 2016. p. 141–63.

    Chapter  Google Scholar 

  12. Greenberg BD, Rauch SL, Haber SN. Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology. 2010;35:317–36.

    Article  PubMed  Google Scholar 

  13. Fernandez de la Cruz L, Rydell M, Runeson B, D’Onofrio BM, Brander G, Ruck C, et al. Suicide in obsessive-compulsive disorder: a population-based study of 36 788 Swedish patients. Mol Psychiatry. 2017;22(11):1626–32.

    Article  CAS  PubMed  Google Scholar 

  14. Lopes AC, Greenberg BD, Canteras MM, Batistuzzo MC, Hoexter MQ, Gentil AF, et al. Gamma ventral capsulotomy for obsessive-compulsive disorder. JAMA Psychiat. 2014;71:1066.

    Article  Google Scholar 

  15. Brown LT, Mikell CB, Youngerman BE, Zhang Y, McKhann GM, Sheth SA. Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies. J Neurosurg. 2016;124:77–89.

    Article  PubMed  Google Scholar 

  16. Manjila S, Rengachary S, Xavier AR, Parker B, Guthikonda M. Modern psychosurgery before Egas Moniz: a tribute to Gottlieb Burckhardt. Neurosurg Focus. 2008;25(1):E9. https://doi.org/10.3171/FOC/2008/25/7/E9.

    Article  PubMed  Google Scholar 

  17. El-Hai J. The lobotomist: a maverick medical genius and his tragic quest to rid the world of mental illness. BMJ. 2005;330:1275.

    Article  Google Scholar 

  18. Sheth SA, Neal J, Tangherlini F, Mian MK, Gentil A, Cosgrove GR, et al. Limbic system surgery for treatment-refractory obsessive-compulsive disorder: a prospective long-term follow-up of 64 patients. J Neurosurg. 2013;118(3):491–7.

    Article  PubMed  Google Scholar 

  19. Woerdeman PA, Willems PW, Noordmans HJ, Berkelbach van der Sprenkel JW, van Rijen PC. Frameless stereotactic subcaudate tractotomy for intractable obsessive-compulsive disorder. Acta Neurochir. 2006;148(6):633–7; discussion 7

    Article  CAS  PubMed  Google Scholar 

  20. Anderson CA, Arciniegas DB. Neurosurgical interventions for neuropsychiatric syndromes. Curr Psychiatry Rep. 2004;6:355–63.

    Article  PubMed  Google Scholar 

  21. Feldman RP, Alterman RL, Goodrich JT. Contemporary psychosurgery and a look to the future. J Neurosurg. 2001;95:944–56.

    Article  CAS  PubMed  Google Scholar 

  22. Jenike MA, Rauch SL, Baer L, Rasmussen SA. Neurosurgical treatment of obsessive-compulsive disorder. In: Jenike MA, Baer L, Minichiello WE, editors. Obsessive-compulsive disorders: practical management. St. Louis: Mosby; 1998. p. 592–610.

    Google Scholar 

  23. Shah DB, Pesiridou A, Baltuch GH, Malone DA, O’Reardon JP. Functional neurosurgery in the treatment of severe obsessive compulsive disorder and major depression: overview of disease circuits and therapeutic targeting for the clinician. Psychiatry (Edgmont). 2008;5:24–33.

    Google Scholar 

  24. Doshi PK. Surgical treatment of obsessive compulsive disorders: current status. Indian J Psychiatry. 2009;51:216–21.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Spofford CM, McLaughlin NCR, Penzel F, Rasmussen SA, Greenberg BD. OCD behavior therapy before and after gamma ventral capsulotomy: case report. Neurocase. 2014;20:42–5.

    Article  PubMed  Google Scholar 

  26. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown obsessive compulsive scale. Arch Gen Psychiatry. 1989;46:1006.

    Article  CAS  PubMed  Google Scholar 

  27. López-Pina JA, Sánchez-Meca J, López-López JA, Marín-Martínez F, Núñez-Núñez RM, Rosa-Alcázar AI, et al. The Yale-Brown obsessive compulsive scale: a reliability generalization meta-analysis. Assessment. 2015;22:619–28.

    Article  PubMed  Google Scholar 

  28. Banks GP, Mikell CB, Youngerman BE, Henriques B, Kelly KM, Chan AK, et al. Neuroanatomical characteristics associated with response to dorsal anterior cingulotomy for obsessive-compulsive disorder. JAMA Psychiat. 2015;72(2):127–35.

    Article  Google Scholar 

  29. Ahmari SE, Dougherty DD. Dissecting OCD circuits: from animal models to targeted treatments. Depress Anxiety. 2015;32:550–62.

    Article  PubMed  PubMed Central  Google Scholar 

  30. McGovern RA, Sheth SA. Role of the dorsal anterior cingulate cortex in obsessive-compulsive disorder: converging evidence from cognitive neuroscience and psychiatric neurosurgery. J Neurosurg. 2017;126:132–47.

    Article  PubMed  Google Scholar 

  31. Kopell BH, Greenberg B, Rezai AR. Deep brain stimulation for psychiatric disorders. J Clin Neurophysiol. 2004;21:51–67.

    Article  PubMed  Google Scholar 

  32. Kopell BH, Rezai AR. The continuing evolution of psychiatric neurosurgery. CNS Spectr. 2000;5:20–31.

    Article  Google Scholar 

  33. Wichmann T, DeLong MR. Deep brain stimulation for neurologic and neuropsychiatric disorders. Neuron. 2006;52:197–204.

    Article  CAS  PubMed  Google Scholar 

  34. Rauch SL, Savage CR, Alpert NM, Fischman AJ, Jenike MA. The functional neuroanatomy of anxiety: a study of three disorders using positron emission tomography and symptom provocation. Biol Psychiatry. 1997;42:446–52.

    Article  CAS  PubMed  Google Scholar 

  35. Nakao T, Nakagawa A, Yoshiura T, Nakatani E, Nabeyama M, Yoshizato C, et al. Brain activation of patients with obsessive-compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: a functional magnetic resonance imaging study. Biol Psychiatry. 2005;57:901–10.

    Article  PubMed  Google Scholar 

  36. Rauch S, Shin LM, Dougherty DD, Alpert NM, Fischman AJ, Jenike MA. Predictors of fluvoxamine response in contamination-related obsessive compulsive disorder a PET symptom provocation study. Neuropsychopharmacology. 2002;27:782–91.

    Article  CAS  PubMed  Google Scholar 

  37. Rauch SL, Dougherty DD, Malone D, Rezai A, Friehs G, Fischman AJ, et al. A functional neuroimaging investigation of deep brain stimulation in patients with obsessive–compulsive disorder. J Neurosurg. 2006;104:558–65.

    Article  PubMed  Google Scholar 

  38. Szeszko PR, Ardekani BA, Ashtari M, Malhotra AK, Robinson DG, Bilder RM, et al. White matter abnormalities in obsessive-compulsive disorder. Arch Gen Psychiatry. 2005;62:782.

    Article  PubMed  Google Scholar 

  39. Hartmann CJ, Lujan JL, Chaturvedi A, Goodman WK, Okun MS, McIntyre CC, et al. Tractography activation patterns in dorsolateral prefrontal cortex suggest better clinical responses in OCD DBS. Front Neurosci. 2016;9:519.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Sheth SA, Ogas P, Eskandar EN. Future of neurosurgery. In: Psychiatric neurotherapeutics. New York: Springer New York; 2016. p. 209–20.

    Chapter  Google Scholar 

  41. Greenberg BD, Gabriels LA, Malone DA, Rezai AR, Friehs GM, Okun MS, et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry. 2010;15:64–79.

    Article  CAS  PubMed  Google Scholar 

  42. Rasmussen S, Greenberg B, Mindus P, Friehs G, Noren G. Neurosurgical approaches to intractable obsessive-compulsive disorder. CNS Spectr. 2000;5(11):23–34.

    Article  CAS  PubMed  Google Scholar 

  43. Knight G. Bifrontal stereotaxic tractotomy in the substantia innominata: an experience of 450 cases. In: Hitchcock E, Laitinen L, Vaernet K, editors. Psychosurgery. Springfield: Charles C Thomas; 1972. p. 267–77.

    Google Scholar 

  44. Newcombe R. The lesion in stereotactic subcaudate tractotomy. Br J Psychiatry. 1975;6:478–81.

    Article  CAS  Google Scholar 

  45. Bourne SK, Sheth SA, Neal J, Strong C, Mian MK, Cosgrove GR, et al. Beneficial effect of subsequent lesion procedures after nonresponse to initial cingulotomy for severe, treatment-refractory obsessive-compulsive disorder. Neurosurgery. 2013;72(2):196–202; discussion

    Article  PubMed  Google Scholar 

  46. Ruck C, Karlsson A, Steele JD, Edman G, Meyerson BA, Ericson K, et al. Capsulotomy for obsessive-compulsive disorder: long-term follow-up of 25 patients. Arch Gen Psychiatry. 2008;65(8):914–21.

    Article  PubMed  Google Scholar 

  47. Miguel EC, Lopes AC, McLaughlin NCR, Noren G, Gentil AF, Hamani C, et al. Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder. Mol Psychiatry. 2019;24(2):218–40.

    Article  PubMed  Google Scholar 

  48. Kim SJ, Roh D, Jung HH, Chang WS, Kim CH, Chang JW. A study of novel bilateral thermal capsulotomy with focused ultrasound for treatment-refractory obsessive-compulsive disorder: 2-year follow-up. J Psychiatry Neurosci. 2018;43(4):170188.

    PubMed  Google Scholar 

  49. Interview with Dr. Benjamin Greenberg, (2017).

    Google Scholar 

  50. Camprodon JA, Rauch SL, Greenberg BD, Dougherty DD. Psychiatric neurotherapeutics: contemporary surgical and device-based treatments. Totowa: Humana Press; 2016. p. 230.

    Google Scholar 

  51. Garnaat SL, Boisseau CL, Yip A, Sibrava NJ, Greenberg BD, Mancebo MC, et al. Predicting course of illness in patients with severe obsessive compulsive disorder. J Clin Psychiatry. 2015;76:e1605–10.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ruck C, Larsson JK, Mataix-Cols D, Ljung R. A register-based 13-year to 43-year follow-up of 70 patients with obsessive-compulsive disorder treated with capsulotomy. BMJ Open. 2017;7(5):e013133.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychiatric Neurosurgery Program at Butler Hospital, Providence, RI, USA

    Adriel Barrios-Anderson & Nicole C. R. McLaughlin

  2. Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Nicole C. R. McLaughlin

Authors
  1. Adriel Barrios-Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicole C. R. McLaughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicole C. R. McLaughlin .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Nader Pouratian

  2. Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA

    Sameer A. Sheth

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Barrios-Anderson, A., McLaughlin, N.C.R. (2020). Obsessive-Compulsive Disorder: Lesions. In: Pouratian, N., Sheth, S. (eds) Stereotactic and Functional Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-34906-6_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-34906-6_30

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-34905-9

  • Online ISBN: 978-3-030-34906-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation