High‐intensity focused ultrasound for noninvasive functional neurosurgery

Martin, Ernst; Jeanmonod, Daniel; Morel, Anne; Zadicario, Eyal; Werner, Beat

doi:10.1002/ana.21801

Cited by 407 publications

(336 citation statements)

References 22 publications

Supporting

Mentioning

331

Contrasting

Unclassified

Order By: Relevance

“…These findings were consistent with those previously reported in a trial of MR imagingguided focused sonography lesioning of the contralateral thalamus for neuropathic pain. 10 Zone III was consistent with vasogenic edema 26,27 ; it was typically seen at 24 hours and 1 week and then resolved. This appearance of lesions and their evolution with time was similar to the imaging findings observed for stereotactic radiofrequency thalamotomies but quite different from those observed with gamma knife radiosurgery.…”

Section: Discussionmentioning

confidence: 92%

“…Further investigation in animal models is needed to elucidate the exact nature of this enhancement, which might be related to neovascularization. 32 Of note, in the previous application of MR imaging-guided focused sonography for neuropathic pain syndromes, 10 enhancement was seen at 24 hours and had resolved by 48 hours. Patients were not imaged beyond 48 hours.…”

Section: Discussionmentioning

confidence: 98%

“…10 There were 3 concentric zones: a hypointense zone I at the center; a strongly hyperintense zone II demarcated by a hypointense rim; and finally, a fuzzy, slightly hyperintense zone III at the periphery (Fig 1). The diameters of zone I and the thicknesses of zones II and III and their evolution with time are reported in Table 2 and Fig 2. The focused sonography lesion in the axial plane, defined by the outline of zone II, was round in 10 patients, a vertical (anteroposterior) oval in 2 patients, and a horizontal (left-right) oval in 3 patients.…”

Section: Imaging Findingsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] MR imaging-guided focused sonography is now accepted in the treatment of soft-tissue disorders, including prostate cancer and uterine fibroids. Intracranial applications for brain tumors 8,9 and neuropathic pain syndromes 10,11 are currently under investigation. More recently, MR imaging-guided focused sonography was tested in a clinical trial as a treatment for essential tremor.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Imaging Findings in MR Imaging-Guided Focused Ultrasound Treatment for Patients with Essential Tremor

Wintermark

Druzgal

Huss³

et al. 2013

American Journal of Neuroradiology

131

115

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: MR imaging-guided focused sonography surgery is a new stereotactic technique that uses high-intensity focused sonography to heat and ablate tissue. The goal of this study was to describe MR imaging findings pre-and post-ventralis intermedius nucleus lesioning by MR imaging-guided focused sonography as a treatment for essential tremor and to determine whether there was an association between these imaging features and the clinical response to MR imaging-guided focused sonography.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 98%

Section: Imaging Findingsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Imaging Findings in MR Imaging-Guided Focused Ultrasound Treatment for Patients with Essential Tremor

Wintermark

Druzgal

Huss³

et al. 2013

American Journal of Neuroradiology

131

115

View full text Add to dashboard Cite

show abstract

“…It does not involve ionizing radiation, is not limited by trajectory restrictions, and is not preclusive for later MRI diagnostics and treatment options. Several clinical phase I trials have demonstrated the feasibility and safety of using tcMRgFUS to treat a variety of functional brain disorders, such as chronic neuropathic pain [2], essential tremor [3,4], or tremordominant Parkinson's disease [5] through thermal ablation of thalamic and subthalamic targets with submilimeter precision [6]. Accordingly, the InSightec Neuro system used in these trials received CE marking for functional neurosurgery by the end of 2012.…”

Section: Introductionmentioning

confidence: 99%

First Non-invasive Thermal Ablation of a Brain Tumor with MR Guided Focused Ultrasound

Coluccia¹,

Fandiño²,

Schwyzer³

et al. 2014

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

Magnetic resonance-guided focused ultrasound surgery (MRgFUS) allows for precise thermal ablation of target tissues. While this emerging modality is increasingly used for the treatment of various types of extracranial soft tissue tumors, it has only recently been acknowledged as a modality for noninvasive neurosurgery. MRgFUS has been particularly successful for functional neurosurgery, whereas its clinical application for tumor neurosurgery has been delayed for various technical and procedural reasons. Here, we report the case of a 63-year-old patient presenting with a centrally located recurrent glioblastoma who was included in our ongoing clinical phase I study aimed at evaluating the feasibility and safety of transcranial MRgFUS for brain tumor ablation. Applying 25 high-power sonications under MR imaging guidance, partial tumor ablation could be achieved without provoking neurological deficits or other adverse effects in the patient. This proves, for the first time, the feasibility of using transcranial MR-guided focused ultrasound to safely ablate substantial volumes of brain tumor tissue.

show abstract

Safety and Efficacy of Focused Ultrasound Thalamotomy for Patients With Medication-Refractory, Tremor-Dominant Parkinson Disease

et al. 2017

View full text Add to dashboard Cite

IMPORTANCE Clinical trials have confirmed the efficacy of focused ultrasound (FUS) thalamotomy in essential tremor, but its effectiveness and safety for managing tremor-dominant Parkinson disease (TDPD) is unknown.OBJECTIVE To assess safety and efficacy at 12-month follow-up, accounting for placebo response, of unilateral FUS thalamotomy for patients with TDPD. DESIGN, SETTING, AND PARTICIPANTSOf the 326 patients identified from an in-house database, 53 patients consented to be screened. Twenty-six were ineligible, and 27 were randomized (2:1) to FUS thalamotomy or a sham procedure at 2 centers from October18, 2012, to January 8, 2015. The most common reasons for disqualification were withdrawal (8 persons [31%]), and not being medication refractory (8 persons [31%]). Data were analyzed using intention-to-treat analysis, and assessments were double-blinded through the primary outcome.INTERVENTIONS Twenty patients were randomized to unilateral FUS thalamotomy, and 7 to sham procedure. The sham group was offered open-label treatment after unblinding. MAIN OUTCOMES AND MEASURESThe predefined primary outcomes were safety and difference in improvement between groups at 3 months in the on-medication treated hand tremor subscore from the Clinical Rating Scale for Tremor (CRST). Secondary outcomes included descriptive results of Unified Parkinson's Disease Rating Scale (UPDRS) scores and quality of life measures. RESULTSOf the 27 patients, 26 (96%) were male and the median age was 67.8 years (interquartile range [IQR], 62.1-73.8 years). On-medication median tremor scores improved 62% (IQR, 22%-79%) from a baseline of 17 points (IQR, 10.5-27.5) following FUS thalamotomy and 22% (IQR, −11% to 29%) from a baseline of 23 points (IQR, 14.0-27.0) after sham procedures; the between-group difference was significant (Wilcoxon P = .04). On-medication median UPDRS motor scores improved 8 points (IQR, 0.5-11.0) from a baseline of 23 points (IQR, 15.5-34.0) following FUS thalamotomy and 1 point (IQR, −5.0 to 9.0) from a baseline of 25 points (IQR, 15.0-33.0) after sham procedures. Early in the study, heating of the internal capsule resulted in 2 cases (8%) of mild hemiparesis, which improved and prompted monitoring of an additional axis during magnetic resonance thermometry. Other persistent adverse events were orofacial paresthesia (4 events [20%]), finger paresthesia (1 event [5%]), and ataxia (1 event [5%]).CONCLUSIONS AND RELEVANCE Focused ultrasound thalamotomy for patients with TDPD demonstrated improvements in medication-refractory tremor by CRST assessments, even in the setting of a placebo response.TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01772693

show abstract

High‐intensity focused ultrasound for noninvasive functional neurosurgery

Abstract: (2009

Cited by 407 publications

References 22 publications

Imaging Findings in MR Imaging-Guided Focused Ultrasound Treatment for Patients with Essential Tremor

Imaging Findings in MR Imaging-Guided Focused Ultrasound Treatment for Patients with Essential Tremor

First Non-invasive Thermal Ablation of a Brain Tumor with MR Guided Focused Ultrasound

Safety and Efficacy of Focused Ultrasound Thalamotomy for Patients With Medication-Refractory, Tremor-Dominant Parkinson Disease

Contact Info

Product

Resources

About