Obsessive compulsive disorder (OCD) is a common disorder thought to have a prevalence of 1-2%. The majority of patients are helped by treatments such as exposure and response prevention therapy and medication. A significant minority fail to benefit from optimal treatment and are severely disabled with respect to everyday function.

Such patients may be candidates for a neurosurgical approach. This talk will trace the development of neurosurgery for severe OCD beginning with leucotomy/lobotomy which was practiced in the early part of the 20th Century and left an unfavourable legacy. Advancements in neurosurgery have allowed techniques such as anterior cingulotomy and anterior capsulotomy to be practiced at present and will be compared. Deep brain stimulation for severe OCD was introduced as an alternative to ablation neurosurgery but the optimal target for electrode placement remains under debate and will be discussed with reference to a study directly comparing DBS of two emerging targets within the same patients. Finally, methods of target refinement will be discussed which may improve patients outcome in the near future.