Included studies — main characteristics (part 1 of 2)
| Author (year, subgroup) | Patients (procedures), n* | Surgery | Surgery setting: software; ablation equipment† | Operation | Lesions per side | Y-BOCS score, preoperative | Y-BOCS score, 12 mo | Y-BOCS score, LFU | LFU response rate, % | LFU, mo |
|---|---|---|---|---|---|---|---|---|---|---|
| Csigo et al.16 (2010) | 5 | Cap | Software (BrainLAB); monopolar electrodes (Radionics) | RF | NR | 38.2 ± 1.8 (> 32) | 19.6 ± 8.6 | 18.2 ± 10.0 | 60 | 24.0 ± 0.0 |
| D’Astous et al.18 (2013) | 19 (21)‡ | Cap | Before 2004: Mec-Inov stereotactic system (NR) After 2004: Stealth Framelink neuronavigation system (NR); leucotome (Bertrand) | Mechanical | 4 | 34.9 ± 4.8 (28–40) | 22.2 ± 5.0 | 23.8 | 37 | 84.0§ (36–132) |
| Gong et al.19 (2018) | 14 | Cap | SurgiPlan 2.1 (Elekta); neurostimulator (Elekta) | RF: 75°C, 60 s | 1 | 29.2 ± 5.4 (18–37) | 10.2 ± 9.2 | 10.2 ± 9.2 | 79 | 12.0 ± 0.0 |
| Gupta et al.20 (2019) | 40 | Cap | NR; Leksell GK models B, U, 4C, Perfexion or Icon (Elekta) | GK: 120–180 Gy | 1 (50%) or 2 (50%) | 35 ± 3.6 (24–40) | NR | 27.5 ± 10.8 | 45 | 30.5 ± 29.7 (6–96) |
| Irle et al.21 (1998, front) | 6 | Front | Pneumoventriculography (NR); NR | RF | 13–25 | Median: 34 Δ IQR: 12 Range: > 24 | NR | Median: 11 Δ IQR: 24 | NR | Median: 22 Δ IQR: 4 Range: NR |
| Irle et al.21 (1998, front + dos) | 5 | Front | Pneumoventriculography (NR); NR | RF | 13–25 | Median: 29 Δ IQR: 12 Range: NR | NR | Median: 12 Δ IQR: 17 | NR | Median: 20 Δ IQR: 10 Range: NR |
| Irle et al.21 (1998, front + pos) | 5 | Front | Pneumoventriculography (NR); NR | RF | 13–25 | Median: 34 Δ IQR: 15 Range: NR | NR | Median: 6 Δ IQR: 14 | NR | Median: 18 Δ IQR: 3 Range: NR |
| Jung et al.22 (2006) | 17 | Cing | NR; 1.8 mm electrode, 10 mm tip (RFG-3C; Radionics) | RF: 85°C, 90 s | 4 | 35.0 ± 3.9 (NR) | 22.4 ± 6.5 | 18.2 ± 4.4 | 47 | 24.0 ± 0.0 |
| Kim et al.23 (2002) | 12 | Limb | Ventriculography in 7, MRI guided in 14 (n = 21); lesion generator (Radionics) | RF | NR | 36.58 ± 2.47 (30–40) | 10.7 ± 2.71 | 3.8 ± 1.6 | 50 | 72.0 ± 0.0 |
| Kim et al.24 (2018) | 11 | Cap | NR; ExAblate 4000 (InSightec) | MRgFUS¶ | NR | 34.4 ± 2.3 (30–38) | 21.8 ± 4.8 | 21.3 ± 6.2 | 55 | 24.0 ± 0.0 |
| Kondziolka et al.25 (2011) | 3 | Cap | NR; NR | GK: 140 or 150 Gy | 2 | 37.3 ± 2.9 (34–39) | NR | 16.7 ± 8.1 | 67 | 41.7 ± 13.5 (28–55) |
| Liu et al.26 (2008) | 35 (37)** | Cap | SurgiPlan 2.1 (Electra); radiofrequency (Radionics) | RF: 70°C or 80°C, 60 s | 3 | 21.2 ± 4.0 (NR) | 5.4 ± 2.1 | 4.4 ± 2.3 | 57 | 36.0 ± 0.0 |
| Lopes et al.27 (2014) | 12 | Cap | NR; gamma knife model B (Elekta) | GK: 180 Gy | 2 | 33.1 ± 3.3 (30–40) | 21.8 ± 12.1 | 16.1 ± 11.9 | 67 | 55.2 ± 23.3 (12–86) |
| Lopes et al.28 (2009) | 5 | Cap | NR; gamma knife model B (Elekta) | GK: 180 Gy | 2 | 32.2 ± 1.5 (30–34) | 20.2 ± 10.4 | 20.6 ± 12.3 | 60 | 48.0 ± 0.0 |
| Montoya et al.29 (2002) | 9 (20)†† | Limb | NR; electrode, 10 mm tip (NR) | RF: 85°C | 1 | 29.3 ± 4.6 (21–37) | NR | 20.8 ± 7.8 | 44 | 26§ (n = 21) (6–59) |
| Oliver et al.30 (2003) | 15 (18) | Cap | Before 2002: none After 2002: Target software (BrainLab); RF3 apparatus, 10_mm electrode (Radionics) | RF: 75°C, 75 s | 2 | 29.67§ (NR) | 17.3§ | 18.2§ | 60 | 24.0 ± 0.0 (24–24) |
| Rasmussen et al.31 (2018, DS) | 40 | Cap | NR; Leksell GK model U (22 patients), model C (18 patients) | GK: 180 Gy | 2 | 34.2 ± 3.2 (≥ 28) | 20.3 ± 7.3 (n = 35) | 16.8 ± 8.3 (n = 32) | 75 | 36.0 ± 0.0 |
| Rasmussen et al.31 (2018, SS) | 15 (28) | Cap | NR; Leksell GK model U | GK: 180 Gy | 1 or 2 | 33.3 ± 4.8 (≥ 28) | 30.7 ± 7.6 | 19.3 ± 11.3 (n = 14) | 47 | 36.0 ± 0.0 |
| Ruck et al.32 (2008, bilateral GK) | 9 (13)‡‡ | Cap | NR; Leksell GK unit (Elekta) | GK: 160, 180 or 200 Gy§§ | 1 or 3 | 33.4 ± 4.2 (27–39) | 17.0 ± 13.9 | 14.3 ± 12.1 | 63 | 139.5 ± 35.1 (n = 8) (84–180) |
| Ruck et al.32 (2008, bilateral RF) | 12 (16)¶¶ | Cap | NR; 1.5 mm electrode, 10 mm tip | RF: 60°C | 1 | 33.9 ± 2.7 (30–38) | 19.0 ± 10.2 | 20.1 ± 10.9 | 45 | 142.0 ± 46.6 (48–204) |
| Ruck et al.32 (2008, unilateral RF) | 4 (5)*** | Cap | NR; 1.5 mm electrode, 10 mm tip | RF: 60°C | 1 | 35.2 ± 3.7 (30–38) | 22.2 ± 15.0 | 19.3 ± 17.5 | 67 | 42.7 ± 11.9 (n = 3) (48–96) |
| Sheehan et al.33 (2013) | 5 | Cap | NR; GK Perfexion unit (Elekta) | GK: 140–160 Gy | 1 | 32.2 ± 1.2 (31–34) | NR | 16.2 ± 7.4 | 80 | 22.2 ± 10.5 (6–33) |
| Sheth et al.34 (2013, cing/limb) | 30 (65)††† | Cing+ | NR; electrode, 10 mm tip (Cosman Medical) | RF: 85°C, 60 s | NR | 31.7 ± 1.0 (NR) | 25.4 ± 8.3 | 17.9 ± 1.7 | 53 | 65.2 ± 54.6 (n = 27) (NR) |
| Sheth et al.34 (2013, cing) | 34 | Cing | NR; electrode, 10 mm tip (Cosman Medical) | RF: 85°C, 60 s | Before 2000: 1 After 2000: 3 | 30.9 ± 7.6 (NR) | 19.5 ± 10.4 | 21.3 ± 1.5 | 35 | 58.5 ± 60.5 (n = 32) (NR) |
| Spatola et al.35 (2018) | 10 | Cap | NR; GK unit (Elekta; before Sep. 2007, model 4C; after Oct. 2007, Perfexion model) | GK: 120 Gy | 2 | 32.7 ± 4.8 (24–38) | NR | 14.7 ± 8.8 | 70 | 41.0 ± 38.4 (6–116) |
| Yang et al.36 (2014, cing) | 11 | Cing | NR; electrode, 10 mm tip (Cosman Medical) | RF | 3 | 33.8 ± 1.3 (NR) | NR | 28.2 ± 8.6 | 18 | 33.5 ± 12.5 (NR) |
| Yang et al.36 (2014, limb) | 8 | Limb | NR; electrode, 10 mm tip (Cosman Medical) | RF | 3 + 2 | 33.7 ± 2.5 (NR) | NR | 20.4 ± 8.5 | 50 | 37.4 ± 19.4 (NR) |
| Yin et al.37 (2018) | 36 | Cap | NR; 2 mm electrode, 2 mm tip (Radionics) | RF: 75°C, 60 s | 2 | 30.1 ± 7.2 (15–40) | NR | 16.3 ± 10.0 | 56 | 7.6 ± 8.6 (1–30) |
| Zhan et al.38 (2014) | 53 | Cap | NR; 2 mm electrode, 2 mm tip (Radionics) | RF: 80°C, 60 s | 2 | 24.7 ± 4.0 (NR) | 6.7 ± 5.4 | 6.5 ± 5.9 | 62 | 67.5§ (60–84) |
| Zhang et al.39 (2013) | 7 | Cing + cap | NR; 1.6 mm electrode, 4 mm tip (NR) | RF: 70°C, 100 s | Cing: 4 Cap: 3 | 32.9 ± 4.7 (27–40) | 20.6 ± 5.3 | 20.6 ± 5.3 | 71 | 12.0 ± 0.0 |
cap = capsulotomy; cing = cingulotomy; cing+: unsuccessful cingulotomy followed by subsequent lesion (a repeat cingulotomy or a subcaudate tractotomy); cing + cap: cingulotomy combined with capsulotomy; dos = extended dorsally to the ventromedial lesion; DS = double shot group; front = frontal leucotomy; GK = gamma knife; IQR = interquartile range; LFU = last follow-up; limb = limbic leucotomy; MRgFUS = magnetic resonance-guided focused ultrasound; NR: not reported; pos = extended posteriorly into the white matter of the orbital cortex underlying the caudate nucleus and to the fundus of the striatum; RF = radiofrequency; SS = single shot repeat group; Y-BOCS = Yale–Brown Obsessive Compulsive Scale.
Note: Unless otherwise indicated, scores and last follow-up months are expressed as mean ± standard deviation (range).
↵* Expressed as number of patients only, if patients had no repeated procedures; expressed as number of patients (total procedures), if patients had at least 1 repeated procedure.
↵† Expressed as software (company); ablation equipment (company).
↵‡ Two times in 2 (due to relapse; 6 and 4 weeks after).
↵§ Standard deviation not reported.
↵¶ Peak temperature 51 to 56°C for > 3 seconds; 23 to 36 sonications, durations of 10–31 seconds; overall procedure lasted 5 to 7 hours.
↵** Two times in 2 (second capsulotomy).
↵†† Two times in 5 (after unsuccessful bilateral anterior cingulotomy); 3 times in 3 (limbic leucotomy was the third procedure after surgical enlargement of the original cingulotomy lesions).
↵‡‡ Two times in 2 (extra bilateral gamma capsulotomy); 3 times in 1 (extra bilateral and unilateral thermo capsulotomy).
↵§§ Gamma knife 160 Gy (2 repeat procedures), 180 Gy (4 patients) or 200 Gy (5 patients).
↵¶¶ Two times in 2 (extra bilateral thermo capsulotomy); 3 times in 1 (extra unilateral thermo cap and cingulotomy).
↵*** Two times in 1 (extra unilateral thermo capsulotomy).
↵††† For 35 (those failed to benefit from first surgery): second procedure in 30, interval 17.3 ± 3.2 months; third procedure in 5, interval 24.3 ± 5.1 months.