High-Intensity Focused Ultrasound Surgery of the Brain

Abstract

The field of MRI-guided high intensity focused ultrasound surgery (MRgFUS) is a rapidly evolving one with many potential applications in neurosurgery. This is the first of three articles on MRgFUS, this paper focuses on the historical development of the technology and it's potential applications to modern neurosurgery. The evolution of MRgFUS has occurred in parallel with modern neurological surgery and the two seemingly distinct disciplines share many of the same pioneering figures. Early studies on focused ultrasound treatment in the 1940's and 1950's demonstrated the ability to perform precise lesioning in the human brain, with a favorable risk-benefit profile. However, the need for a craniotomy, as well as lack of sophisticated imaging technology resulted in limited growth of HIFU for neurosurgery. More recently, technological advances, have permitted the combination of HIFU along with MRI guidance to provide an opportunity to effectively treat a variety of CNS disorders. Although challenges remain, HIFU-mediated neurosurgery may offer the ability to target and treat CNS conditions that were previously extremely difficult to perform. The remaining two articles in this series will focus on the physical principles of modern MRgFUS as well as current and future avenues for investigation.

Magnetic resonance–guided interstitial high-intensity focused ultrasound for brain tumor ablation

“…7 Since that time, modern HIFU treatment systems have evolved to include thermal ablation, intraprocedural anatomy- and temperature- sensitive MRI guidance, and the use of ultrasound phased arrays to correct for cranial distortion. 11 The Insightec MRI-guided HIFU (MRgHIFU) unit, ExAblate 3000, was one of the first to include all 3 of these features and was used for primate feasibility studies in 2006. 9 In 2008, McDannold et al published the first case report in which they described the clinical application of MRgHIFU in 3 patients with GBM; they indicated how multiple focused ultrasound exposures were applied up to the maximum acoustic power available at the time.…”

The use of transcranial focused ultrasound in CNS diseases

“…Биофизические эффекты ФУЗ описаны в ряде работ [13,14]. Ультразвук представляет собой распространение в среде упругих волн механических колебаний.…”

Magnetic Resonance–Guided Focused Ultrasound Surgery

“…The physical principles underlying focused ultrasound surgery have been well outlined previously 7-10 and will only be briefly recounted as they pertain to therapeutic applications.…”