Lesion location and lesion creation affect outcomes after focused ultrasound thalamotomy.

Autor:	Segar DJ; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Lak AM; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Lee S; Department of Neuroscience, Brown University, Providence, RI, USA., Harary M; Department of Neurosurgery, University of California, Los Angeles, CA, USA., Chavakula V; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Lauro P; Department of Neuroscience, Brown University, Providence, RI, USA., McDannold N; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., White J; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Cosgrove GR; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Brain : a journal of neurology [Brain] 2021 Nov 29; Vol. 144 (10), pp. 3089-3100.
DOI:	10.1093/brain/awab176
Abstrakt:	MRI-guided focused ultrasound thalamotomy has been shown to be an effective treatment for medication refractory essential tremor. Here, we report a clinical-radiological analysis of 123 cases of MRI-guided focused ultrasound thalamotomy, and explore the relationships between treatment parameters, lesion characteristics and outcomes. All patients undergoing focused ultrasound thalamotomy by a single surgeon were included. The procedure was performed as previously described, and patients were followed for up to 1 year. MRI was performed 24 h post-treatment, and lesion locations and volumes were calculated. We retrospectively evaluated 118 essential tremor patients and five tremor-dominant Parkinson's disease patients who underwent thalamotomy. At 24 h post-procedure, tremor abated completely in the treated hand in 81 essential tremor patients. Imbalance, sensory disturbances and dysarthria were the most frequent acute adverse events. Patients with any adverse event had significantly larger lesions, while inferolateral lesion margins were associated with a higher incidence of motor-related adverse events. Twenty-three lesions were identified with irregular tails, often extending into the internal capsule; 22 of these patients experienced at least one adverse event. Treatment parameters and lesion characteristics changed with increasing surgeon experience. In later cases, treatments used higher maximum power (normalized to skull density ratio), accelerated more quickly to high power, and delivered energy over fewer sonications. Larger lesions were correlated with a rapid rise in both power delivery and temperature, while increased oedema was associated with rapid rise in temperature and the maximum power delivered. Total energy and total power did not significantly affect lesion size. A support vector regression was trained to predict lesion size and confirmed the most valuable predictors of increased lesion size as higher maximum power, rapid rise to high-power delivery, and rapid rise to high tissue temperatures. These findings may relate to a decrease in the energy efficiency of the treatment, potentially due to changes in acoustic properties of skull and tissue at higher powers and temperatures. We report the largest single surgeon series of focused ultrasound thalamotomy to date, demonstrating tremor relief and adverse events consistent with reported literature. Lesion location and volume impacted adverse events, and an irregular lesion tail was strongly associated with adverse events. High-power delivery early in the treatment course, rapid temperature rise, and maximum power were dominant predictors of lesion volume, while total power, total energy, maximum energy and maximum temperature did not improve prediction of lesion volume. These findings have critical implications for treatment planning in future patients. (© The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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