• Stephanie Toscano Kasabkojian, Alexandre Jack Dwan, Maria Paula Maziero, Antonio de Salles, Alessandra Gorgulho, Eurípedes Constantino Miguel, Fillipo de Queiroz Vattimo Edoardo E Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil., and Antonio Carlos Lopes.
• Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
• World Neurosurg. 2021 Jan 1; 145: 298-300.

BackgroundGamma Knife ventral anterior capsulotomy is an effective option to treat refractory obsessive-compulsive disorder. Although well tolerated, complications can develop years after radiosurgery. We describe a case in which abnormal complications induced by very high doses of radiation evolved.Case DescriptionA 55-year-old man with refractory obsessive-compulsive disorder was treated with Gamma Knife ventral anterior capsulotomy using a dose of 180 Gy. His obsessive-compulsive symptoms improved, but his condition evolved with a manic episode, cognitive memory changes, visual hallucinations, confabulation, and frontal lobe symptoms. Magnetic resonance imaging showed brain edema in the left hemisphere and a 6-mm brain cyst in the right hemisphere at postoperative month 20.ConclusionsThis case shows the consequences of affecting more fibers related to the anterior frontal region than intended with a radiosurgical procedure and illustrates the importance of careful clinical and imaging follow-up after Gamma Knife ventral anterior capsulotomy.Copyright © 2020 Elsevier Inc. All rights reserved.

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