Dr. Ramesh Doddamani Podcast

This video illustrates the technique of robotic-guided bilateral cingulotomy using radiofrequency ablation for a 23-year-old patient with treatment-resistant obsessive-compulsive disorder (OCD) that failed to improve with medications, augmentation agents, and cognitive-behavioral therapy.

Bilateral cingulotomy is a form of stereotactic psychosurgery that involves creating precise lesions in the anterior cingulate cortex, a key limbic brain region involved in emotional regulation and compulsive behavior. Traditionally performed with frame-based techniques, this procedure can be enhanced with robotic guidance to improve accuracy and safety.

In the operative video, robotic trajectory planning using the ROSA platform is performed to localize targets in the anterior cingulate bilaterally. After small burr holes are drilled, a radiofrequency probe is advanced under robotic control and intraoperative imaging confirmation to create controlled thermocoagulation lesions in the cingulate gyrus. The minimally invasive approach reduces surgical morbidity while ensuring precise lesion placement.

The patient demonstrated significant clinical improvement at 1-year follow-up, with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score reduced by more than 50% compared to preoperative scores, indicating meaningful symptom relief.

This procedure represents an advanced option for patients with severe, refractory OCD who have exhausted medical and behavioral therapies. It underscores the evolving role of robotic stereotactic neurosurgery in treating complex psychiatric conditions with improved precision and outcomes.