Neurosurgical procedures for refractory OCD

his lecture will review the four main neurosurgical operations (cingulotomy, limbic leucotomy, anterior capsulotomy, subcaudate tractotomy) that have been used throughout the world for the last few decades to treat patients with refractory OCD. The modern criteria to define which patients should undergo these operations will be considered; definitions of “treatment-refractory” will be operationalized. Both early efficacy studies and more modern data will be reviewed. Ongoing research endeavors, including a controlled trial, will be discussed and preliminary findings presented. Possible rationale for and biological implications of these surgical procedures will be reviewed, including the relationships of the lesion sites to recent neuroimaging findings. Possible future directions will also be covered.