Department of Neurosurgery, University of Utah, 175 North Medical Drive East, 5th Floor, Salt Lake City, UT 84132, USA.
Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street Suite 9A, Houston, TX 77030, USA.
Psychiatr Clin North Am. 2023 Mar;46(1):121-132. doi: 10.1016/j.psc.2022.11.002. Epub 2022 Dec 13.
Treatment-resistant obsessive-compulsive disorder (trOCD) is a severely disabling, life-threatening psychiatric disorder affecting ∼0.5% of the US population. Following the failure of multiple medical and psychotherapeutic treatment lines, patients with trOCD, like others with functional disorders, may benefit from invasive neuromodulation. Cumulative evidence suggests that disrupting abnormal hyperdirect cortico-striato-thalamo-cortical (CSTC) pathway activity offers sustainable, robust symptomatic relief in most patients. Multiple surgical approaches allow for modulation of the CSTC pathway, including stereotactic lesions and electrical stimulation. This review aims to describe the modern neurosurgical approaches for trOCD, recent advances in our understanding of pathophysiology, and future therapeutic directions.
治疗抵抗性强迫症（trOCD）是一种严重致残、危及生命的精神疾病，影响美国人口的约 0.5%。在多次医学和心理治疗方法失败后，像其他功能性障碍患者一样，trOCD 患者可能受益于侵入性神经调节。累积证据表明，破坏异常的皮质-纹状体-丘脑-皮质（CSTC）通路的过度活跃活动，可为大多数患者提供可持续、稳健的症状缓解。多种手术方法可用于调节 CSTC 通路，包括立体定向损伤和电刺激。这篇综述旨在描述 trOCD 的现代神经外科方法、我们对病理生理学的最新理解，以及未来的治疗方向。
