I also have very bad OCD and have entertained the idea of surgery in the past, I've failed all the meds due to side effects and live over 2 hours from the nearest CBT doc (and can't travel 2 hours due to my OCD) so I've been kind of on my own in figuring out how to handle things. I'm no doc, but I have carefully looked into the options for severe cases and experimental treatments. Gamma knife seems safer than the standard surgeries, but I have heard of cases where up to five surgeries failed to help, standard (several different approaches) and gamma knife or a mix of both. I have yet to hear a great success story from surgery. Combined meds is another idea, risperidal or similar drugs with ssri's has been shown to help some people, same thing with some of the epilepsy meds combined with ssri's. There are some studies of once weekly morphine doses that show promise, even for patients that have failed multiple surgeries (I think Stanford was running a study). A bunch of other meds have been known to help sometimes. Another idea is long term hospital care at a specialized facility, McLean (I think I got that right) Hospital near Boston is often considered the best of these, the criteria for getting in is similar to that for gamma knife, multi med resistent and failed CBT. My advice as someone in a similar position is to explore all your options (brain surgery is forever). I've decided to wait and see, I'm looking for a new doc, waiting for the outcome of the morphine studies, and investigating the effectiveness of combining gabapentin with an ssri (I've heard this can work and I'm looking for a doc who has heard of the approach). Good luck to you and let us know how it turns out.