Robotic Guided Bilateral Anterior Cingulate Radiofrequency Ablation for Obsessive-Compulsive Disorder.
Background
Bilateral anterior cingulotomy (BAC) constitutes the most commonly performed procedure for treatment of refractory OCD. Evolution of stereotactic procedures has rekindled the interest in the effective management of refractory psychiatric disorders, especially OCD with utmost safety and excellent outcomes.


Objective
The aim of this study was to demonstrate the technique of performing BAC under robotic guidance using radiofrequency ablation with an operative video.


Procedure
A 23-year-old gentleman diagnosed with symptoms of OCD for a duration of 8 years and was refractory to conventional therapy. The trajectories for BAC were planned on the robotic platform (ROSA, Zimmer-Biomet, Warsaw, Indiana, USA). The target point was selected on the anterior cingulate, approximately 2 cms posterior to the anterior most point of the frontal horn, 2-3 mm above the corpus callosum and 7 mm lateral to the midline. Pre coronal (1 cm anterior and 3 cms lateral to midline) holes of 2.5 mm diameter were made using pneumatic handheld drill. Radiofrequency (RF) thermocoagulation of the anterior cingulum was performed using an RF probe of 2.2 mm diameter and 4 mm uninsulated tip under robotic guidance after confirming the position with intraoperative O-arm imaging bilaterally.


Results
The surgery was uneventful and the patient had a significant improvement following surgery, with the Yale Brown Obsessive Compulsive Scale of 18 at 1 year follow-up compared to the preoperative score of 36.


Conclusion
Robotic-guided BAC is a safe and effective technique for the treatment of drug-refractory OCD. Intraoperative O arm CT augments the precision of the lesions created.
['Doddamani|Ramesh Sharanappa|RS|', 'Samala|Raghu|R|', 'Agrawal|Mohit|M|', 'Verma|Rohit|R|', 'Kumar|Nand|N|', 'Chandra|Poodipedi Sarat|PS|']
D000328:Adult D006179:Gyrus Cinguli D006801:Humans D021621:Imaging, Three-Dimensional D008297:Male D009771:Obsessive-Compulsive Disorder D004364:Pharmaceutical Preparations D000078703:Radiofrequency Ablation D065287:Robotic Surgical Procedures D025321:Surgery, Computer-Assisted D014057:Tomography, X-Ray Computed D016896:Treatment Outcome D055815:Young Adult
o-arm Anterior cingulate cortex cognitive and behaviour therapy frameless stereotaxy radiofrequency thermocoagulation treatment refractory OCD
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