Obsessive-compulsive disorder surgery

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]

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.^[1]

• 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.^[1]

The ablative procedures used for OCD treatment include:^[1]

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

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].

• 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]

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

OR

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

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