Results Following Gamma Knife Radiosurgical Anterior Capsulotomies for Obsessive Compulsive Disorder
Results Following Gamma Knife Radiosurgical Anterior Capsulotomies for Obsessive Compulsive Disorder
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DOI：
10.1227/neu.0b013e3181fc5c8b
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发表时间：
2011-01-01
期刊：
影响因子：
4.8
通讯作者：
Hudak, Robert
中科院分区：
文献类型：
--
作者：
Kondziolka, Douglas;Flickinger, John C.;Hudak, Robert
背景：强迫症（OCD），在其严重的形式，可以造成巨大的残疾患者。目的：评价双侧放射前囊切开术治疗重症难治性强迫症的效果。方法：对3例极端难治性强迫症患者行伽玛刀前囊切开术（GKAC）。根据我们的方案，所有患者至少由2名精神科医生评估，并建议进行手术治疗。根据耶鲁-布朗强迫症量表（YBOCS），患者必须要求进行手术，并且必须患有严重的强迫症。患者年龄分别为37岁、55岁和40岁，放疗前YBOCS评分分别为34/40、39/40和39/40。双侧病变用2个4-mm等中心点在腹膜中点的内囊腹侧形成一个椭圆形体积。使用的最大剂量为140或150戈瑞。结果：手术后无发病，所有患者立即恢复到基线功能。所有患者都有明显的功能改善，强迫症行为减少。随访时间分别为55、42和28个月。第一位患者的YBOCS评分从34分降至24分。一名强迫性抠皮和开放性伤口的患者慢性伤口愈合较晚，YBOCS评分从39分降至8分。28个月时，第三例患者独立生活和工作，YBOCS评分为18。结论：在严格的治疗方案下，伽玛刀放射治疗可改善强迫症行为，无不良反应。该技术应进一步评估患者的严重和致残性行为障碍。
BACKGROUND: Obsessive compulsive disorder (OCD), in its severe form, can cause tremendous disability for affected patients.OBJECTIVE: To evaluate the results following bilateral radiosurgical anterior capsulotomy for severe medically refractory OCD.METHODS: We performed gamma knife anterior capsulotomy (GKAC) on 3 patients with extreme, medically intractable OCD. According to our protocol, all patients were evaluated by at least 2 psychiatrists who recommended surgery. The patient had to request the procedure, and had to have severe OCD according to the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patient ages were 37, 55, and 40 years, and pre-radiosurgery YBOCS scores were 34/40, 39/40, and 39/40. Bilateral lesions were created with 2 4-mm isocenters to create an oval volume in the ventral internal capsule at the putaminal midpoint. A maximum dose of 140 or 150 Gy was used.RESULTS: There was no morbidity after the procedure, and all patients returned immediately to baseline function. All patients noted significant functional improvements, and reduction in OCD behavior. Follow-up was at 55, 42, and 28 months. The first patient reduced her YBOCS score from 34 to 24. One patient with compulsive skin picking and an open wound had later healing of the chronic wound and a reduction in the YBOCS score from 39 to 8. At 28 months, the third patient is living and working independently, and her YBOCS score is 18.CONCLUSION: Within a strict protocol, gamma knife radiosurgery provided improvement of OCD behavior with no adverse effects. This technique should be evaluated further in patients with severe and disabling behavioral disorders.