Stereotactic Radiosurgery Capsulotomy for Intractable Severe Obsessive-Compulsive Disorder: A Systematic Review, Meta-Analysis, and International Stereotactic Radiosurgery Society Practice Guidelines
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.034 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.020 |
| Bibliometrics | 0.010 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".