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Safety and accuracy of incisionless transcranial MR-guided focused ultrasound functional neurosurgery: single-center experience with 253 targets in 180 treatments.
J Neurosurg 2018; :1-10JN

Abstract

OBJECTIVES

ince the first clinical application of the incisionless magnetic resonance-guided focused ultrasound (MRgFUS) technology only small series of patients have been reported, and thus only extrapolations of the procedure-related risks could be offered. In this study, the authors analyze side-effects and targeting accuracy in 180 consecutive treatments with MRgFUS for chronic therapy-resistant idiopathic Parkinson's disease (PD), essential tremor (ET), cerebellar tremor (CT), and neuropathic pain (NP), all performed in their dedicated center.

METHODS

A total of 180 treatments with MRgFUS for chronic therapy-resistant idiopathic PD, ET, CT, and NP were prospectively assessed for side-effects and targeting accuracy. Monitoring for later side-effects was continued for at least 3 months after the procedure in all but 1 case (0.6%); in that single case, the patient was lost to follow-up after an uneventful early postoperative course. The surgical targets were the pallidothalamic tract (pallidothalamic tractotomy, n = 105), the cerebellothalamic tract (cerebellothalamic tractotomy, n = 50), the central lateral nucleus (central lateral thalamotomy, n = 84), the centrum medianum (centrum medianum thalamotomy, n = 12), and the globus pallidus (pallidotomy, n = 2). Cognitive testing was performed before, 1-2 days after, and 1 year after the procedure. The Mini-Mental State Examination (MMSE) was used for the first 29 cases and was then replaced by the Montreal Cognitive Assessment (MoCA). Lesion reconstruction and measurement of targeting accuracy were done on 2-day posttreatment MR images for each performed target. To determine targeting accuracy measurement, 234 out of the 253 lesions depicted in the 2-day postoperative MR examination could be 3D-reconstructed.

RESULTS

The mean MoCA score was slightly improved 2 days postoperatively (p = 0.002) and remained stable at 1-year follow-up (p = 0.03). The mean MMSE score was also slightly improved 2 days postoperatively and at 1-year follow-up, but the improvement was not statistically significant (p = 0.06 and p = 0.2, respectively). The mean (± SD) accuracy was 0.32 ± 0.29 mm, 0.29 ± 0.28 mm, and 0.44 ± 0.39 mm for the mediolateral, anteroposterior, and dorsoventral dimensions, respectively. The mean 3D accuracy was 0.73 ± 0.39 mm. As to side-effects, 14 events over 180 treatments were documented. They were classified into procedure-related (n = 4, 2.2%), effect on neighboring structures (n = 3, 1.7%), and disease-related (n = 7, 3.9%). There was no bleeding.

CONCLUSIONS

The incisionless transcranial MRgFUS technology demonstrates a higher targeting accuracy and a lower side-effect profile than techniques requiring cerebral penetration. In the absence of penetration brain shift, this technique avoids the placement of a thermolesion away from the chosen target, thus suppressing the need for reversible therapeutic energy application. With the use of proper physiopathology-based targets, definitive therapeutic effects can be coupled with sparing of sensory, motor, and paralimbic/multimodal thalamocortical functions. Clinical efficacy, not analyzed in this investigation, will ultimately rest in proper target selection and optimized thermolesional coverage of the target.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

29799340

Citation

Gallay, Marc N., et al. "Safety and Accuracy of Incisionless Transcranial MR-guided Focused Ultrasound Functional Neurosurgery: Single-center Experience With 253 Targets in 180 Treatments." Journal of Neurosurgery, 2018, pp. 1-10.
Gallay MN, Moser D, Jeanmonod D. Safety and accuracy of incisionless transcranial MR-guided focused ultrasound functional neurosurgery: single-center experience with 253 targets in 180 treatments. J Neurosurg. 2018.
Gallay, M. N., Moser, D., & Jeanmonod, D. (2018). Safety and accuracy of incisionless transcranial MR-guided focused ultrasound functional neurosurgery: single-center experience with 253 targets in 180 treatments. Journal of Neurosurgery, pp. 1-10. doi:10.3171/2017.12.JNS172054.
Gallay MN, Moser D, Jeanmonod D. Safety and Accuracy of Incisionless Transcranial MR-guided Focused Ultrasound Functional Neurosurgery: Single-center Experience With 253 Targets in 180 Treatments. J Neurosurg. 2018 May 1;1-10. PubMed PMID: 29799340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and accuracy of incisionless transcranial MR-guided focused ultrasound functional neurosurgery: single-center experience with 253 targets in 180 treatments. AU - Gallay,Marc N, AU - Moser,David, AU - Jeanmonod,Daniel, Y1 - 2018/05/01/ PY - 2017/08/21/received PY - 2017/12/11/accepted PY - 2018/5/26/pubmed PY - 2018/5/26/medline PY - 2018/5/26/entrez KW - AC = anterior commissure KW - AP = anteroposterior KW - CLT = central lateral thalamotomy KW - CMT = centrum medianum thalamotomy KW - CT = cerebellar tremor KW - CTT = cerebellothalamic tractotomy KW - DBS = deep brain stimulation KW - DV = dorsoventral KW - ET = essential tremor KW - ML = mediolateral KW - MMSE = Mini–Mental State Examination KW - MRgFUS KW - MRgFUS = MR-guided focused ultrasound KW - MoCA = Montreal Cognitive Assessment KW - NP = neuropathic pain KW - PC = posterior commissure KW - PD = Parkinson’s disease KW - PTT = pallidothalamic tractotomy KW - Parkinson’s disease KW - RF = radiofrequency KW - accuracy KW - central lateral thalamotomy KW - centrum medianum thalamotomy KW - cerebellothalamic tractotomy KW - chronic neuropathic/neurogenic pain KW - essential tremor KW - pallidothalamic tractotomy KW - safety KW - stereotactic functional neurosurgery SP - 1 EP - 10 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVESince the first clinical application of the incisionless magnetic resonance-guided focused ultrasound (MRgFUS) technology only small series of patients have been reported, and thus only extrapolations of the procedure-related risks could be offered. In this study, the authors analyze side-effects and targeting accuracy in 180 consecutive treatments with MRgFUS for chronic therapy-resistant idiopathic Parkinson's disease (PD), essential tremor (ET), cerebellar tremor (CT), and neuropathic pain (NP), all performed in their dedicated center.METHODSA total of 180 treatments with MRgFUS for chronic therapy-resistant idiopathic PD, ET, CT, and NP were prospectively assessed for side-effects and targeting accuracy. Monitoring for later side-effects was continued for at least 3 months after the procedure in all but 1 case (0.6%); in that single case, the patient was lost to follow-up after an uneventful early postoperative course. The surgical targets were the pallidothalamic tract (pallidothalamic tractotomy, n = 105), the cerebellothalamic tract (cerebellothalamic tractotomy, n = 50), the central lateral nucleus (central lateral thalamotomy, n = 84), the centrum medianum (centrum medianum thalamotomy, n = 12), and the globus pallidus (pallidotomy, n = 2). Cognitive testing was performed before, 1-2 days after, and 1 year after the procedure. The Mini-Mental State Examination (MMSE) was used for the first 29 cases and was then replaced by the Montreal Cognitive Assessment (MoCA). Lesion reconstruction and measurement of targeting accuracy were done on 2-day posttreatment MR images for each performed target. To determine targeting accuracy measurement, 234 out of the 253 lesions depicted in the 2-day postoperative MR examination could be 3D-reconstructed.RESULTSThe mean MoCA score was slightly improved 2 days postoperatively (p = 0.002) and remained stable at 1-year follow-up (p = 0.03). The mean MMSE score was also slightly improved 2 days postoperatively and at 1-year follow-up, but the improvement was not statistically significant (p = 0.06 and p = 0.2, respectively). The mean (± SD) accuracy was 0.32 ± 0.29 mm, 0.29 ± 0.28 mm, and 0.44 ± 0.39 mm for the mediolateral, anteroposterior, and dorsoventral dimensions, respectively. The mean 3D accuracy was 0.73 ± 0.39 mm. As to side-effects, 14 events over 180 treatments were documented. They were classified into procedure-related (n = 4, 2.2%), effect on neighboring structures (n = 3, 1.7%), and disease-related (n = 7, 3.9%). There was no bleeding.CONCLUSIONSThe incisionless transcranial MRgFUS technology demonstrates a higher targeting accuracy and a lower side-effect profile than techniques requiring cerebral penetration. In the absence of penetration brain shift, this technique avoids the placement of a thermolesion away from the chosen target, thus suppressing the need for reversible therapeutic energy application. With the use of proper physiopathology-based targets, definitive therapeutic effects can be coupled with sparing of sensory, motor, and paralimbic/multimodal thalamocortical functions. Clinical efficacy, not analyzed in this investigation, will ultimately rest in proper target selection and optimized thermolesional coverage of the target. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/29799340/Safety_and_accuracy_of_incisionless_transcranial_MR-guided_focused_ultrasound_functional_neurosurgery:_single-center_experience_with_253_targets_in_180_treatments L2 - https://thejns.org/doi/10.3171/2017.12.JNS172054 DB - PRIME DP - Unbound Medicine ER -