Stereotactic Radiosurgery Capsulotomy for Intractable Severe Obsessive-Compulsive Disorder: A Systematic Review, Meta-Analysis, and International Stereotactic Radiosurgery Society Practice Guidelines

S Farzad Maroufi; Mohammad Sadegh Fallahi; Rupesh Kotecha; Laura Fariselli; Alessandra Gorgulho; Marc Levivier; Lijun Ma; Ian Paddick; Jean Regis; John H Suh; Shoji Yomo; Arjun Sahgal; Jason P Sheehan

doi:10.1227/neu.0000000000003842

Stereotactic Radiosurgery Capsulotomy for Intractable Severe Obsessive-Compulsive Disorder: A Systematic Review, Meta-Analysis, and International Stereotactic Radiosurgery Society Practice Guidelines

Neurosurgery. 2025 Nov 11. doi: 10.1227/neu.0000000000003842. Online ahead of print.

Authors

S Farzad Maroufi^{1

2}, Mohammad Sadegh Fallahi¹, Rupesh Kotecha³, Laura Fariselli⁴, Alessandra Gorgulho^{5

6}, Marc Levivier⁷, Lijun Ma⁸, Ian Paddick⁹, Jean Regis¹⁰, John H Suh¹¹, Shoji Yomo¹², Arjun Sahgal¹³, Jason P Sheehan¹⁴

Affiliations

¹ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
³ Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.
⁴ Unit of Radiotherapy, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C Besta, Milan, Italy.
⁵ Department of Neurosurgery, State University of São Paulo, NeuroSapiens Group, São Paulo, Brazil.
⁶ D'Or Institute for Research and Education, São Paulo, Brazil.
⁷ Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
⁸ Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA.
⁹ Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, UK.
¹⁰ Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Marseille, France.
¹¹ Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA.
¹² Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan.
¹³ Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
¹⁴ Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.

PMID: 41217390
DOI: 10.1227/neu.0000000000003842

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.

Keywords: Capsulotomy; Guideline; Obsessive-compulsive disorder; Stereotactic radiosurgery.