PDF(Pubmed)
Abstract：
UNASSIGNED: Anterior capsulotomy is one of the therapeutic options for refractory obsessive-compulsive disorder (OCD). Safety and efficacy of Gamma Knife Capsulotomy (GKC) have been demonstrated in the past.
UNASSIGNED: To characterize changes induced by GKC using a fixel-based analysis (FBA) and possible predictors of efficacy.
UNASSIGNED: Patients with OCD refractory to other therapies underwent bilateral GKC with 120 Gy as a maximum dose on the anterior limb of the internal capsule (ALIC). The clinical outcome was percent reduction in Yale- Brown Obsessive-Compulsive Scale (Y-BOCS). White Matter changes were analyzed using fixel-based analysis (FBA) for fibre density (FD), fibre-bundle cross-section (FC) and the combination of the two (FDC).
UNASSIGNED: Seven patients underwent GKC. Median follow-up was 13 months (range 12-58 months). Mean (±SD) decrease in Y-BOCS score at last follow-up was 61 % ± 35 % with five patients considered as responders. FBA showed a symmetric FD reduction in the ALIC with extension to the anterior fronto-thalamic radiation; a reduction of FC along the superior longitudinal fasciculus (SLF) in both hemispheres with a predominance in the left one. Reductions in FDC were detected predominantly in the right hemisphere, with a similar pattern to FD reductions and associated with a positive correlation (p < 0.05) between Y-BOCS reduction and fibres passing in the ventral part.
UNASSIGNED: GKC is safe and efficient in reducing OCD severity in selected patients. Changes induced in white matter by GKC extend over the ALIC. Reduction of fibres passing the ventral part of the right sided ALIC correlates with better results.
UNASSIGNED: To characterize changes induced by GKC using a fixel-based analysis (FBA) and possible predictors of efficacy.
UNASSIGNED: Patients with OCD refractory to other therapies underwent bilateral GKC with 120 Gy as a maximum dose on the anterior limb of the internal capsule (ALIC). The clinical outcome was percent reduction in Yale- Brown Obsessive-Compulsive Scale (Y-BOCS). White Matter changes were analyzed using fixel-based analysis (FBA) for fibre density (FD), fibre-bundle cross-section (FC) and the combination of the two (FDC).
UNASSIGNED: Seven patients underwent GKC. Median follow-up was 13 months (range 12-58 months). Mean (±SD) decrease in Y-BOCS score at last follow-up was 61 % ± 35 % with five patients considered as responders. FBA showed a symmetric FD reduction in the ALIC with extension to the anterior fronto-thalamic radiation; a reduction of FC along the superior longitudinal fasciculus (SLF) in both hemispheres with a predominance in the left one. Reductions in FDC were detected predominantly in the right hemisphere, with a similar pattern to FD reductions and associated with a positive correlation (p < 0.05) between Y-BOCS reduction and fibres passing in the ventral part.
UNASSIGNED: GKC is safe and efficient in reducing OCD severity in selected patients. Changes induced in white matter by GKC extend over the ALIC. Reduction of fibres passing the ventral part of the right sided ALIC correlates with better results.
摘要：
■前囊切开术是难治性强迫症（OCD）的治疗选择之一。过去已经证明了伽玛刀囊切开术（GKC）的安全性和有效性。
■使用基于fixel的分析（FBA）和可能的疗效预测因子来表征GKC引起的变化。
■对其他治疗无效的强迫症患者进行双侧GKC治疗，最大剂量为120Gy内囊前肢（ALIC）。临床结果是Yale-Brown强迫症量表（Y-BOCS）的减少百分比。使用基于fixel的纤维密度（FD）分析（FBA）的白质变化，光纤束横截面(FC)和两者的组合(FDC)。
■7名患者接受了GKC。中位随访时间为13个月（12-58个月）。最后一次随访时Y-BOCS评分的平均（±SD）下降为61％±35％，其中五名患者被视为响应者。FBA在ALIC中显示出对称的FD减少，并延伸到前额丘脑辐射；在两个半球中，沿着上纵向束（SLF）的FC减少，在左侧占优势。FDC的减少主要在右半球检测到，具有与FD减少相似的模式，并且与Y-BOCS减少与腹侧部分通过的纤维之间呈正相关（p<0.05）。
■GKC在降低部分患者的OCD严重程度方面是安全有效的。GKC诱导的白质变化在ALIC上延伸。通过右侧ALIC腹侧部分的纤维的减少与更好的结果相关。
■使用基于fixel的分析（FBA）和可能的疗效预测因子来表征GKC引起的变化。
■对其他治疗无效的强迫症患者进行双侧GKC治疗，最大剂量为120Gy内囊前肢（ALIC）。临床结果是Yale-Brown强迫症量表（Y-BOCS）的减少百分比。使用基于fixel的纤维密度（FD）分析（FBA）的白质变化，光纤束横截面(FC)和两者的组合(FDC)。
■7名患者接受了GKC。中位随访时间为13个月（12-58个月）。最后一次随访时Y-BOCS评分的平均（±SD）下降为61％±35％，其中五名患者被视为响应者。FBA在ALIC中显示出对称的FD减少，并延伸到前额丘脑辐射；在两个半球中，沿着上纵向束（SLF）的FC减少，在左侧占优势。FDC的减少主要在右半球检测到，具有与FD减少相似的模式，并且与Y-BOCS减少与腹侧部分通过的纤维之间呈正相关（p<0.05）。
■GKC在降低部分患者的OCD严重程度方面是安全有效的。GKC诱导的白质变化在ALIC上延伸。通过右侧ALIC腹侧部分的纤维的减少与更好的结果相关。
