Introduction: A bilateral anterior capsulotomy effectively treats refractory obsessive-compulsive disorder (OCD). We investigated the geometry of lesions and disruption of white matter pathways within the anterior limb of the internal capsule (ALIC) in patients with different outcomes. Methods: In this retrospective study, we analyzed data from 18 patients with refractory OCD who underwent capsulotomies. Patients were grouped into “responders” and “nonresponders” based on the percentage of decrease in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) after surgery. We investigated neurobehavioral adverse effects and analyzed the overlap between lesions and the ventromedial prefrontal (vmPFC) and dorsolateral prefrontal (dlPFC) pathways. Probabilistic maps were constructed to investigate the relationship between lesion location and clinical outcomes. Results: Of the 18 patients who underwent capsulotomies, 12 were responders (>35% improvement in YBOCS), and six were nonresponders. The vmPFC pathway was more involved than the dlPFC pathway in responders (p = 0.01), but no significant difference was observed in nonresponders (p = 0.10). The probabilistic voxel-wise efficacy map showed a relationship between ventral voxels within the ALIC with symptom improvement. Weight gains occurred in 11/18 (61%) patients and could be associated with medial voxels within the ALIC. Conclusion: The optimal outcome after capsulotomy in refractory OCD is linked to vmPFC disruption in the ALIC. Medial voxels within the ALIC could be associated with weight gains following capsulotomy.

1.
Kessler
RC
,
Berglund
P
,
Demler
O
,
Jin
R
,
Merikangas
KR
,
Walters
EE
.
Lifetime prevalence and age-of-onset distributions' of DSM-IV disorders in the national comorbidity survey replication
.
Arch Gen Psychiatry
.
2005 Jun
62
6
593
602
.
2.
Lopes
AC
,
de Mathis
ME
,
Canteras
MM
,
Salvajoli
JV
,
Del Porto
JA
,
Miguel
EC
.
Atualização sobre o tratamento neurocirúrgico do transtorno obsessivo-compulsivo
.
Braz J Psychiatry
.
2004
;
26
(
1
):
62
6
.
3.
Lai
YJ
,
Wang
T
,
Zhang
CC
,
Lin
GZ
,
Voon
V
,
Chang
J
.
Effectiveness and safety of neuroablation for severe and treatment-resistant obsessive-compulsive disorder: a systematic review and meta-analysis
.
J Psychiatry Neurosci
.
2020 Sep
45
5
356
69
.
4.
Lopes
AC
,
Greenberg
BD
,
Noren
G
,
Canteras
MM
,
Busatto
GF
,
de Mathis
ME
.
Treatment of resistant obsessive-compulsive disorder with ventral capsular/ventral striatal gamma capsulotomy: a pilot prospective study
.
J Neuropsychiatry Clin Neurosci
.
2009
;
21
(
4
):
381
92
.
5.
D’Astous
M
,
Cottin
S
,
Roy
M
,
Picard
C
,
Cantin
L
.
Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up
.
J Neurol Neurosurg Psychiatry
.
2013 Nov
84
11
1208
13
.
6.
Zhan
S
,
Liu
W
,
Li
D
,
Pan
S
,
Pan
Y
,
Li
Y
.
Long-term follow-up of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder
.
Clin Neurol Neurosurg
.
2014 Apr
119
91
5
.
7.
Rasmussen
SA
,
Noren
G
,
Greenberg
BD
,
Marsland
R
,
McLaughlin
NC
,
Malloy
PJ
.
Gamma ventral capsulotomy in intractable obsessive-compulsive disorder
.
Biol Psychiatry
.
2018 Sep 1
84
5
355
64
.
8.
Gupta
A
,
Shepard
MJ
,
Xu
Z
,
Maiti
T
,
Martinez-Moreno
N
,
Silverman
J
.
An international radiosurgery Research foundation multicenter retrospective study of gamma ventral capsulotomy for obsessive compulsive disorder
.
Neurosurg
.
2019 Dec 1
85
6
808
16
.
9.
McLaughlin
NCR
,
Lauro
PM
,
Patrick
MT
,
Pucci
FG
,
Barrios-Anderson
A
,
Greenberg
BD
.
Magnetic resonance imaging-guided laser thermal ventral capsulotomy for intractable obsessive-compulsive disorder
.
Neurosurg
.
2021 May 13
88
6
1128
35
.
10.
Mindus
P
,
Edman
G
,
Andreewitch
S
.
A prospective, long-term study of personality traits in patients with intractable obsessional illness treated by capsulotomy
.
Acta Psychiatr Scand
.
1999 Jan
99
1
40
50
.
11.
Ruck
C
,
Karlsson
A
,
Steele
JD
,
Edman
G
,
Meyerson
BA
,
Ericson
K
.
Capsulotomy for obsessive-compulsive disorder - long-term follow-up of 25 patients
.
Arch Gen Psychiatry
.
2008
;
65
(
8
):
914
21
.
12.
McLaughlin
NCRNP
,
Banks
GP
,
Miguel
EC
,
Sheehan
J
,
Lopes
AC
.
Gamma knife capsulotomy for intractable OCD: impact of lesion size and location
.
Biol Psychiatry
.
2017
.
13.
Satzer
DI
,
Mahavadi
A
,
Lacy
M
,
Grant
J
,
Warnke
PC
.
Interstitial laser anterior capsulotomy for obsessive-compulsive disorder: lesion size and tractography correlate with outcome
.
Neurosurg
.
2022
;
93
(
3
):
317
23
.
14.
Avants
BB
,
Epstein
CL
,
Grossman
M
,
Gee
JC
.
Symmetric diffeomorphic image registration with cross-correlation: evaluating automated labeling of elderly and neurodegenerative brain
.
Med Image Anal
.
2008
;
12
(
1
):
26
41
.
15.
Jenkinson
M
,
Beckmann
CF
,
Behrens
TE
,
Woolrich
MW
,
Smith
SM
.
FSL
.
Neuroimage
.
2012 Aug 15
62
2
782
90
.
16.
Varentsova
A
,
Zhang
SW
,
Arfanakis
K
.
Development of a high angular resolution diffusion imaging human brain template
.
Neuroimage
.
2014 May 1
91
177
86
.
17.
Johansen-Berg
H
,
Behrens
TEJ
,
Sillery
E
,
Ciccarelli
O
,
Thompson
AJ
,
Smith
SM
.
Functional-anatomical validation and individual variation of diffusion tractography-based segmentation of the human thalamus
.
Cereb Cortex
.
2005 Jan
15
1
31
9
.
18.
Ruck
C
,
Andreewitch
S
,
Flyckt
K
,
Edman
G
,
Nyman
H
,
Meyerson
BA
.
Capsulotomy for refractory anxiety disorders: long-term follow-up of 26 patients
.
Am J Psychiatry
.
2003 Mar
160
3
513
21
.
19.
Csigo
K
,
Harsanyi
A
,
Demeter
G
,
Rajkai
C
,
Nemeth
A
,
Racsmany
M
.
Long-term follow-up of patients with obsessive-compulsive disorder treated by anterior capsulotomy: a neuropsychological study
.
J Affect Disord
.
2010
126
1–2
198
205
.
20.
Spatola
G
,
Martinez-Alvarez
R
,
Martinez-Moreno
N
,
Rey
G
,
Linera
J
,
Rios-Lago
M
.
Results of gamma knife anterior capsulotomy for refractory obsessive-compulsive disorder: results in a series of 10 consecutive patients
.
J Neurosurg
.
2019
;
131
(
2
):
376
83
.
21.
Davidson
B
,
Hamani
C
,
Meng
Y
,
Baskaran
A
,
Sharma
S
,
Abrahao
A
.
Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness
.
Transl Psychiatry
.
2020
;
10
(
1
):
397
.
22.
Gong
F
,
Li
P
,
Li
B
,
Zhang
S
,
Zhang
X
,
Yang
S
.
A study of cognitive function in treatment-refractory obsessive-compulsive disorder treated with capsulotomy
.
J Neurosurg
.
2018 Feb
128
2
583
95
.
23.
Miguel
EC
,
Lopes
AC
,
McLaughlin
NCR
,
Noren
G
,
Gentil
AF
,
Hamani
C
.
Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder
.
Mol Psychiatry
.
2019
;
24
(
2
):
218
40
.
24.
Safadi
Z
,
Grisot
G
,
Jbabdi
S
,
Behrens
TE
,
Heilbronner
SR
,
McLaughlin
NCR
.
Functional segmentation of the anterior limb of the internal capsule: linking white matter abnormalities to specific connections
.
J Neurosci
.
2018 Feb 21
38
8
2106
17
.
25.
Haber
SN
.
Corticostriatal circuitry
.
Dialogues Clin Neurosci
.
2016 Mar
18
1
7
21
.
26.
Greene
DJ
,
Marek
S
,
Gordon
EM
,
Siegel
JS
,
Gratton
C
,
Laumann
TO
.
Integrative and network-specific connectivity of the basal ganglia and thalamus defined in individuals
.
Neuron
.
2020
;
105
(
4
):
742
58.e6
.
27.
Zhang
C
,
Kim
SG
,
Li
J
,
Zhang
Y
,
Lv
Q
,
Zeljic
K
.
Anterior limb of the internal capsule tractography: relationship with capsulotomy outcomes in obsessive-compulsive disorder
.
J Neurol Neurosurg Psychiatry
.
2021 Jan 18
92
6
637
44
.
28.
Avecillas-Chasin
JM
,
Hurwitz
TA
,
Bogod
NM
,
Honey
CR
.
Tractography-guided anterior capsulotomy for major depression and obsessive-compulsive disorder: targeting the emotion network
.
Oper Neurosurg
.
2021 Mar 15
20
4
406
12
.
29.
Liu
W
,
Li
D
,
Sun
F
,
Zhang
X
,
Wang
T
,
Zhan
S
.
Long-term follow-up study of MRI-guided bilateral anterior capsulotomy in patients with refractory anorexia nervosa
.
Neurosurg
.
2018 Jul 1
83
1
86
92
.
You do not currently have access to this content.