Gupta Rishabh, Chen Jeffrey W, Hughes Natasha C, Hamo Mohammad, Jean-Baptiste Samuel, Paulo Danika L, Chanbour Hani, Fan Run, Ye Fei, Vadali Abhiram, Cmelak Anthony, Bick Sarah K
1University of Minnesota Medical School, Minneapolis, Minnesota.
Departments of2Neurosurgery.
J Neurosurg. 2024 Mar 29;141(2):394-405. doi: 10.3171/2024.1.JNS231537. Print 2024 Aug 1.
Anterior capsulotomy (AC) is a therapeutic option for patients with severe, treatment-resistant obsessive-compulsive disorder (OCD). The procedure can be performed via multiple techniques, with stereotactic radiosurgery (SRS) gaining popularity because of its minimally invasive nature. The risk-benefit profile of AC performed specifically with SRS has not been well characterized. Therefore, the primary objective of this study was to characterize outcomes following stereotactic radiosurgical AC in OCD patients.
Studies assessing mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores before and after stereotactic radiosurgical AC for OCD were included in this analysis. Inverse-variance fixed-effect modeling was used for pooling, and random-effects estimate of the ratio of means and standard mean differences were calculated at 6 months, 12 months, and the last follow-up for Y-BOCS scores, as well as the last follow-up for the Beck Depression Inventory (BDI)/BDI-II scores. A generalized linear mixed model was used to generate fixed- and random-effects models for categorical outcomes. Univariate random-effects meta-regression was used to evaluate associations between postoperative Y-BOCS scores and study covariates. Adverse events were summed across studies. Publication bias was assessed with Begg's test.
Eleven studies with 180 patients were eligible for inclusion. The mean Y-BOCS score decreased from 33.28 to 17.45 at the last-follow up (p < 0.001). Sixty percent of patients were classified as responders and 10% as partial responders, 18% experienced remission, and 4% had worsened Y-BOCS scores. The degree of improvement in the Y-BOCS score correlated with time since surgery (p = 0.046). In the random-effects model, the mean BDI at the last follow-up was not significantly different from that preoperatively. However, in an analysis performed with available paired pre- and postoperative BDI/BDI-II scores, there was significant improvement in the BDI/BDI-II scores postoperatively. Adverse events numbered 235, with headaches, weight change, mood changes, worsened depression/anxiety, and apathy occurring most commonly.
Stereotactic radiosurgical AC is an effective technique for treating OCD. Its efficacy is similar to that of AC performed via other lesioning techniques.
前囊切开术（AC）是重度、难治性强迫症（OCD）患者的一种治疗选择。该手术可通过多种技术进行，立体定向放射外科手术（SRS）因其微创性而越来越受欢迎。专门采用SRS进行AC的风险效益情况尚未得到充分描述。因此，本研究的主要目的是描述OCD患者立体定向放射外科AC后的结果。
本分析纳入了评估OCD患者立体定向放射外科AC前后平均耶鲁-布朗强迫症量表（Y-BOCS）评分的研究。采用逆方差固定效应模型进行汇总，并计算Y-BOCS评分在6个月、12个月和最后一次随访时的均值比和标准均值差的随机效应估计值，以及贝克抑郁量表（BDI）/BDI-II评分的最后一次随访值。使用广义线性混合模型生成分类结局的固定效应和随机效应模型。单变量随机效应meta回归用于评估术后Y-BOCS评分与研究协变量之间的关联。汇总各研究中的不良事件。采用Begg检验评估发表偏倚。
11项研究共180例患者符合纳入标准。最后一次随访时，平均Y-BOCS评分从33.28降至17.45（p< 0.001）。60%的患者被归类为有反应者，10%为部分反应者，18%实现缓解，4%的患者Y-BOCS评分恶化。Y-BOCS评分的改善程度与术后时间相关（p = 0.046）。在随机效应模型中，最后一次随访时的平均BDI与术前无显著差异。然而，在对可用的术前和术后配对BDI/BDI-II评分进行的分析中，术后BDI/BDI-II评分有显著改善。不良事件共235例，最常见的是头痛、体重变化、情绪变化、抑郁/焦虑加重和冷漠。
立体定向放射外科AC是治疗OCD的有效技术。其疗效与通过其他毁损技术进行的AC相似。
