Obsessive-compulsive disorder surgery

Obsessive-compulsive disorder Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyanka Kumari, M.B.B.S[2] Sonya Gelfand, Usama Talib, BSc, MD [3]

Overview

For some patients with severe OCD, neither medication, support groups nor psychological treatments are helpful in alleviating obsessive-compulsive symptoms. These patients may choose to undergo psychosurgery as a last resort. Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue, although their efficacy has not been conclusively demonstrated.

Surgery

Psychosurgery

• For patients whose condition does not improve with other medications and treatments, procedures may be the chosen course of treatment.
• These patients may choose to undergo psychosurgery as a last resort. In this procedure, a surgical lesion is made in an area of the brain (the cingulate bundle). In one study, 30% of participants benefited significantly from this procedure.
• Deep-brain stimulation and vagus nerve stimulation are possible surgical options which do not require the destruction of brain tissue, however their efficacy has not been established.

Ablative procedures

The ablative procedures used for OCD treatment include:

• Anterior cingulotomy
• Capsulotomy
• Subcaudate tractotomy
• Limbic leucotomy (combining anterior cingulotomy and capsulotomy)

Overview

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Indications

• Surgical intervention is not recommended for the management of [disease name].

OR

• Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:
  • [Indication 1]
  • [Indication 2]
  • [Indication 3]
• The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
  • [Indication 1]
  • [Indication 2]
  • [Indication 3]

Surgery

• The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

• Surgery is the mainstay of treatment for [disease or malignancy].