Sebastian R Schreglmann1,2, Stefan Hägele-Link2, Beat Werner3, Ernst Martin3, Georg Kägi4. 1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London (UCL), London, Großbritannien. 2. Klinik für Neurologie, Kantonsspital St. Gallen, Rorschacherstraße 95, 9007, St. Gallen, Schweiz. 3. Zentrum für MR-Forschung, Universitäts-Kinderkliniken Zürich, Zürich, Schweiz. 4. Klinik für Neurologie, Kantonsspital St. Gallen, Rorschacherstraße 95, 9007, St. Gallen, Schweiz. georg.kaegi@kssg.ch.
Abstract
BACKGROUND: The development of high-intensity magnetic resonance imaging (MRI)-guided focused ultrasound (MRIgFUS) ablation has widened the spectrum of interventional techniques for stereotactic functional neurosurgery of lesions. This has resulted in novel incisionless intervention approaches for the therapy of tremor disorders. The safety and efficacy is documented by recent study data. OBJECTIVES: This article encompasses a description of the technological basis and typical course of MRIgFUS interventions, a comparison to alternative open or incisionless surgical techniques as well as a review of the current evidence base for MRIgFUS ablation in the context of lesional interventions to treat tremor. MATERIAL AND METHODS: Narrative literature review and comparison. RESULTS: Depending on the surgical target and tremor etiology published trials of MRIgFUS ablation report a reduction of tremor intensity of up to 80% after 6-12 months follow-up without the disadvantages of open brain surgery. CONCLUSION: The MRIgFUS functional neurosurgery is conducted only at a limited number of treatment sites. First data on lesions of the thalamic ventral intermediary nucleus (V.im.) as well as subthalamic fiber tracts have been published. These results indicate an effective and safe treatment of tremor disorders by MRIgFUS ablation. Incisionless lesional surgery using MRIgFUS is a significant addition to the interventional armamentarium for functional stereotactic neurosurgery and a potentially valuable alternative to established interventional therapy options for tremor disorders.
BACKGROUND: The development of high-intensity magnetic resonance imaging (MRI)-guided focused ultrasound (MRIgFUS) ablation has widened the spectrum of interventional techniques for stereotactic functional neurosurgery of lesions. This has resulted in novel incisionless intervention approaches for the therapy of tremor disorders. The safety and efficacy is documented by recent study data. OBJECTIVES: This article encompasses a description of the technological basis and typical course of MRIgFUS interventions, a comparison to alternative open or incisionless surgical techniques as well as a review of the current evidence base for MRIgFUS ablation in the context of lesional interventions to treat tremor. MATERIAL AND METHODS: Narrative literature review and comparison. RESULTS: Depending on the surgical target and tremor etiology published trials of MRIgFUS ablation report a reduction of tremor intensity of up to 80% after 6-12 months follow-up without the disadvantages of open brain surgery. CONCLUSION: The MRIgFUS functional neurosurgery is conducted only at a limited number of treatment sites. First data on lesions of the thalamic ventral intermediary nucleus (V.im.) as well as subthalamic fiber tracts have been published. These results indicate an effective and safe treatment of tremor disorders by MRIgFUS ablation. Incisionless lesional surgery using MRIgFUS is a significant addition to the interventional armamentarium for functional stereotactic neurosurgery and a potentially valuable alternative to established interventional therapy options for tremor disorders.
Authors: Sebastian R Schreglmann; Ronald Bauer; Stefan Hägele-Link; Kailash P Bhatia; Parashkev Natchev; Nikolas Wegener; Anita Lebeda; Beat Werner; Ernst Martin; Georg Kägi Journal: Neurology Date: 2017-03-08 Impact factor: 9.910
Authors: W Jeffrey Elias; Diane Huss; Tiffini Voss; Johanna Loomba; Mohamad Khaled; Eyal Zadicario; Robert C Frysinger; Scott A Sperling; Scott Wylie; Stephen J Monteith; Jason Druzgal; Binit B Shah; Madaline Harrison; Max Wintermark Journal: N Engl J Med Date: 2013-08-15 Impact factor: 91.245