Introduction: We describe a novel use of laser ablation for lesioning of bilateral anterior internal capsules in the treatment of obsessive-compulsive disorder (OCD). To date, three major modalities have been used for the creation of lesions in patients with OCD – stereotactic radiosurgery (SRS), radiofrequency ablation (RF) and deep brain stimulation (DBS). Disadvantages to SRS and DBS include delayed time to therapeutic response, where RF ablations are performed without real time monitoring. Major advantages of MR guided laser ablation include the immediate effect, as well as the ability to monitor lesion size and design the lesion whilst we create it with real time MRI Thermography. This allows for more precise and reproducible lesions, which we hypothesize will correlate with improved outcomes.
Methods: We present one patient, suffering from refractory obsessive-compulsive disorder, who underwent MR-guided laser ablation of the anterior limb of bilateral internal capsules with Visualase Thermal Therapy system.
Results: She experienced no complications and a significant improvement in her OCD symptoms. Her pre-operative Yale Brown Obsessive Compulsive (YBOC) score was 39, which improved to 28 by 36 hours after surgery.
Conclusions: To the best of our knowledge, we present the first case of anterior internal capsulotomy with laser ablation for the treatment of OCD. Continued follow up, as well as further studies with larger cohorts, will be needed for validation of efficacy and safety.
Patient Care: MR guided laser interstitial thermal therapy provides real time monitoring of lesioning with promising preliminary results.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the options for treatment of medically refractory obsessive compulsive disorder. 2) Discuss, in small groups, safety, outcomes, and technical nuances of stereotactic radiosurgery, radiofrequency, deep brain stimulation and MR guided laser ablation performed lesioning for treatment of medically refractory OCD.