Neurosurgery · 2025
Stereotactic Radiosurgery Capsulotomy for Intractable Severe Obsessive-Compulsive Disorder: A Systematic Review, Meta-Analysis, and International Stereotactic Radiosurgery Society Practice Guidelines.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Maroufi S Farzad, Fallahi Mohammad Sadegh, Kotecha Rupesh, Fariselli Laura, Gorgulho Alessandra, Levivier Marc, Ma Lijun, Paddick Ian, Regis Jean, Suh John H, Yomo Shoji, Sahgal Arjun, Sheehan Jason P
Аннотация
BACKGROUND AND OBJECTIVES: Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition affecting 1%-3% of the population. Although standard treatments are effective for most, approximately 10% are treatment-refractory. Stereotactic radiosurgery capsulotomy (SRSC) is an emerging treatment for severe and refractory patients. This study systematically reviews and meta-analyzes the efficacy and safety of SRSC for OCD and provides practice guidelines.
METHODS: PubMed, Embase, Web of Science, and Scopus were searched for relevant studies. Inclusion criteria encompassed studies with ≥3 patients treated with SRSC, reporting OCD-specific outcomes and a minimum follow-up of 6 months. Primary outcomes included Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), remission (Y-BOCS ≤16), and complete responses (≥35% reduction in Y-BOCS). Secondary outcomes were partial response rates, adverse events, and changes in depression and functioning. Meta-analyses were conducted using R.
RESULTS: Seventeen studies were included, representing 254 patients with a mean age of 37 years and a baseline Y-BOCS score of 32.78. At final follow-up, SRSC achieved a 46.52% reduction in Y-BOCS scores (95% CI 36.72-56.32), with 56.48% of patients achieving complete response and 49.30% attaining remission. Global functioning significantly improved, whereas depression scores showed minimal changes. Prognostic factors for greater response included female sex, longer disease duration, and older age. Adverse events were mild, with weight change (36.13%), transient mood disturbances (0.15 incidence rate), and headache (6.67%) being the most common. Serious complications, including necrosis (0.92%) and radiation-induced changes (2.96%), were rare.
CONCLUSION: SRSC demonstrates efficacy in reducing OCD symptoms with an acceptable safety profile in a treatment-refractory population. Consensus guidelines are provided to guide clinical practice.
METHODS: PubMed, Embase, Web of Science, and Scopus were searched for relevant studies. Inclusion criteria encompassed studies with ≥3 patients treated with SRSC, reporting OCD-specific outcomes and a minimum follow-up of 6 months. Primary outcomes included Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), remission (Y-BOCS ≤16), and complete responses (≥35% reduction in Y-BOCS). Secondary outcomes were partial response rates, adverse events, and changes in depression and functioning. Meta-analyses were conducted using R.
RESULTS: Seventeen studies were included, representing 254 patients with a mean age of 37 years and a baseline Y-BOCS score of 32.78. At final follow-up, SRSC achieved a 46.52% reduction in Y-BOCS scores (95% CI 36.72-56.32), with 56.48% of patients achieving complete response and 49.30% attaining remission. Global functioning significantly improved, whereas depression scores showed minimal changes. Prognostic factors for greater response included female sex, longer disease duration, and older age. Adverse events were mild, with weight change (36.13%), transient mood disturbances (0.15 incidence rate), and headache (6.67%) being the most common. Serious complications, including necrosis (0.92%) and radiation-induced changes (2.96%), were rare.
CONCLUSION: SRSC demonstrates efficacy in reducing OCD symptoms with an acceptable safety profile in a treatment-refractory population. Consensus guidelines are provided to guide clinical practice.