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Obsessive-Compulsive Disorder: Lesions

  • Adriel Barrios-Anderson
  • Nicole C. R. McLaughlinEmail author
Chapter
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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.

Keywords

Obsessive-compulsive disorder Stereotactic ablation Neuroablation Cingulotomy Capsulotomy Subcaudate tractotomy Limbic leucotomy Psychiatric neurosurgery Functional neurosurgery Lesion procedures 

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

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Adriel Barrios-Anderson
    • 1
  • Nicole C. R. McLaughlin
    • 1
    • 2
    Email author
  1. 1.Psychiatric Neurosurgery Program at Butler HospitalProvidenceUSA
  2. 2.Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown UniversityProvidenceUSA

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