Lesion Topography and Outcome after Thermocapsulotomy or Gamma Knife Capsulotomy for Obsessive-Compulsive Disorder: Relevance of the Right Hemisphere

Lesion Topography and Outcome after Thermocapsulotomy or Gamma Knife Capsulotomy for... AbstractOBJECTIVES:Obsessive-compulsive disorder is a common mental disorder, notorious for its chronicity and intractability. Stereotactic lesions within the anterior limb of the internal capsule have been shown to provide symptomatic relief in such refractory cases, but only few systematic evaluations have correlated anatomic lesion location with individual postoperative outcome.PATIENTS AND METHODS:Between 1976 and 1989, extremely disabled and otherwise intractable patients with a chronic deteriorating clinical course of obsessive-compulsive disorder underwent bilateral thermocapsulotomy (n = 22) or radiosurgical gamma knife capsulotomy (n = 13) at the Karolinska Hospital, Stockholm. Clinical morbidity was monitored prospectively pre- and postoperatively by using standardized psychiatric rating scales. In 29 patients (thermocapsulotomy, n = 19; gamma knife capsulotomy, n = 10), both psychiatric and magnetic resonance imaging follow-up data (median, 8.4 yr) were available.RESULTS:A right-sided anatomically defined lesion volume was identified in all successfully treated patients. This common topographic denominator was defined in the approximate middle of the anterior limb of the internal capsule on the plane parallel to the anterior commissure-posterior commissure line at the level of the foramen of Monro and 4 mm above on the plane defined by the internal cerebral vein. This region was unaffected in patients with poor outcomes. On the left side, no particular lesion topography was associated with clinical outcome. Topographic differences of lesion overlap between good and poor outcome groups were significant tor the right side (Fisher's exact test, P < 0.005).CONCLUSION:The current anatomic long-term analysis after thermocapsulotomy or gamma knife capsulotomy tor obsessive-compulsive disorder reveals common topographic features within the right-sided anterior limb of the internal capsule independent of treatment modality. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Lesion Topography and Outcome after Thermocapsulotomy or Gamma Knife Capsulotomy for Obsessive-Compulsive Disorder: Relevance of the Right Hemisphere

Lesion Topography and Outcome after Thermocapsulotomy or Gamma Knife Capsulotomy for Obsessive-Compulsive Disorder: Relevance of the Right Hemisphere

Lesion Topography and Outcome after Thermocapsulotomy or Gamma Knife Capsulotomy for Obsessive-Compulsive Disorder: Relevance of the Right Hemisphere Bodo E. Lippitz, M .D ., Per Mindus, M .D ., Ph.D ., Bjorn A. Meyerson, M .D ., Ph.D., Lars Kihlstrom, M .D ., Christer Lindquist, M .D ., Ph.D. Departments of Neurosurgery (BEL, BAM, LK, CL) and Psychiatry (PM), Karolinska Institute and Hospital, Stockholm, Sweden O B JEC T IV ES: Obsessive-com pulsive disorder is a common mental disorder, notorious for its chronicity and intrac­ tability. Stereotactic lesions within the anterior limb of the internal capsule have been shown to provide symptomatic relief in such refractory cases, but only few systematic evaluations have correlated anatomic lesion location with individual postoperative outcome. PATIENTS A N D M E T H O D S : Between 1976 and 1989, extremely disabled and otherwise intractable patients with a chronic deteriorating clinical course of obsessive-compulsive disorder underwent bilateral thermocapsulotomy (n = 22) or radiosurgical gamma knife capsulotomy (n = 13) at the Karolinska Hospital, Stockholm. Clinical morbidity was monitored prospectively pre- and postoperatively by using standardized psychiatric rating scales. In 29 patients (thermocapsulotomy, n = 19; gamma knife capsulotomy, n = 10), both psychiatric and magnetic resonance imaging follow-up data (median, 8.4 yr) were available. RESULTS: A right-sided anatom ically defined lesion volume was identified in all successfully treated patients. This common topographic denominator was defined in the approximate middle of the anterior limb of the internal capsule on the plane parallel to the anterior commissure-posterior commissure line at the level of the foramen of Monro and 4 mm above on the plane defined by the internal cerebral vein. This region was unaffected in patients with poor outcomes. O n the left side, no particular lesion topography was associated with clinical outcome. Topographic...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199903000-00005
Publisher site
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Abstract

AbstractOBJECTIVES:Obsessive-compulsive disorder is a common mental disorder, notorious for its chronicity and intractability. Stereotactic lesions within the anterior limb of the internal capsule have been shown to provide symptomatic relief in such refractory cases, but only few systematic evaluations have correlated anatomic lesion location with individual postoperative outcome.PATIENTS AND METHODS:Between 1976 and 1989, extremely disabled and otherwise intractable patients with a chronic deteriorating clinical course of obsessive-compulsive disorder underwent bilateral thermocapsulotomy (n = 22) or radiosurgical gamma knife capsulotomy (n = 13) at the Karolinska Hospital, Stockholm. Clinical morbidity was monitored prospectively pre- and postoperatively by using standardized psychiatric rating scales. In 29 patients (thermocapsulotomy, n = 19; gamma knife capsulotomy, n = 10), both psychiatric and magnetic resonance imaging follow-up data (median, 8.4 yr) were available.RESULTS:A right-sided anatomically defined lesion volume was identified in all successfully treated patients. This common topographic denominator was defined in the approximate middle of the anterior limb of the internal capsule on the plane parallel to the anterior commissure-posterior commissure line at the level of the foramen of Monro and 4 mm above on the plane defined by the internal cerebral vein. This region was unaffected in patients with poor outcomes. On the left side, no particular lesion topography was associated with clinical outcome. Topographic differences of lesion overlap between good and poor outcome groups were significant tor the right side (Fisher's exact test, P < 0.005).CONCLUSION:The current anatomic long-term analysis after thermocapsulotomy or gamma knife capsulotomy tor obsessive-compulsive disorder reveals common topographic features within the right-sided anterior limb of the internal capsule independent of treatment modality.

Journal

NeurosurgeryOxford University Press

Published: Mar 1, 1999

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