Initial experience with magnetic resonance-guided focused ultrasound stereotactic surgery for central brain lesions in young adults.

Autor:	Tierney TS; 1Department of Brain Sciences, Imperial College London, London, United Kingdom., Alavian KN; 1Department of Brain Sciences, Imperial College London, London, United Kingdom., Altman N; 2Department of Radiology.; Departments of3Radiology.; Departments of4Radiology., Bhatia S; 5Division of Neurosurgery, Brain Institute, and.; 6Neurosurgery, and., Duchowny M; 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital.; 8Neurology, University of Miami Miller School of Medicine; and.; 9Neurology., Hyslop A; 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital.; 10Pediatrics, and., Jayakar P; 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital.; 11Neurosciences and Biomedical Engineering, Florida International University, Miami, Florida., Resnick T; 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital.; 8Neurology, University of Miami Miller School of Medicine; and.; 9Neurology., Wang S; 5Division of Neurosurgery, Brain Institute, and.; 6Neurosurgery, and., Miller I; 7Division of Neurology, Brain Institute, Nicklaus Children's Hospital., Ragheb J; 5Division of Neurosurgery, Brain Institute, and.; 6Neurosurgery, and.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2022 Jan 14; Vol. 137 (3), pp. 760-767. Date of Electronic Publication: 2022 Jan 14 (Print Publication: 2022).
DOI:	10.3171/2021.10.JNS21416
Abstrakt:	Objective: Magnetic resonance-guided focused ultrasound (MRgFUS) is an incisionless procedure capable of thermoablation through the focus of multiple acoustic beams. Although MRgFUS is currently approved for the treatment of tremor in adults, its safety and feasibility profile for intracranial lesions in the pediatric and young adult population remains unknown. Methods: The long-term outcomes of a prospective single-center, single-arm trial of MRgFUS at Nicklaus Children's Hospital in Miami, Florida, are presented. Patients 15-22 years of age with centrally located lesions were recruited, clinically consistent with WHO grade I tumors that require surgical intervention. This cohort consisted of 4 patients with hypothalamic hamartoma (HH), and 1 patient with tuberous sclerosis complex harboring a subependymal giant cell astrocytoma (SEGA). Results: In each case, high-intensity FUS was used to target the intracranial lesion. Real-time MRI was used to monitor the thermoablations. Primary outcomes of interest were tolerability, feasibility, and safety of FUS. The radiographic ablation volume on intra- and postoperative MRI was also assessed. All 5 patients tolerated the procedure without any complications. Successful thermoablation was achieved in 4 of the 5 cases; the calcified SEGA was undertreated due to intratumor calcification, which prevented attainment of the target ablation temperature. The HHs underwent target tissue thermoablations that led to MR signal changes at the treatment site. For the patients harboring HHs, FUS thermoablations occurred without procedure-related complications and led to improvement in seizure control or hypothalamic hyperphagia. All 5 patients were discharged home on postoperative day 1 or 2, without any readmissions. There were no cases of hemorrhage, electrolyte derangement, endocrinopathy, or new neurological deficit in this cohort. Conclusions: This experience demonstrates that FUS thermoablation of centrally located brain lesions in adolescents and young adults can be performed safely and that it provides therapeutic benefit for associated symptoms.
Databáze:	MEDLINE
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