Successful magnetic resonance-guided focused ultrasound treatment of tremor in patients with a skull density ratio of 0.4 or less.

Autor:	Vetkas A; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Boutet A; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto.; 2Joint Department of Medical Imaging, University of Toronto, Ontario, Canada., Sarica C; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Germann J; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Gwun D; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Yamamoto K; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Jung HH; 3Center for Innovative Functional Neurosurgery, Brain Research Institute, Seoul.; 4Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea., Alkhotani A; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Samuel N; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Lang S; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Conner CR; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Elias GJB; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Cheyuo C; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Chow C; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Santyr B; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto.; 5Schulich School of Medicine and Dentistry, Western University, London, Ontario., Iorio-Morin C; 6Division of Neurosurgery, CHUS Research Center, University of Sherbrooke, Québec., Yang AZ; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Candeias da Silva C; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto., Fasano A; 7Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto.; 8Department of Medicine, Division of Neurology, University of Toronto.; 9Krembil Research Institute, Toronto.; 10CRANIA, University Health Network and University of Toronto; and.; 11The KITE Research Institute, University Health Network, Toronto, Ontario, Canada., Kalia SK; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto.; 9Krembil Research Institute, Toronto.; 10CRANIA, University Health Network and University of Toronto; and.; 11The KITE Research Institute, University Health Network, Toronto, Ontario, Canada., Lozano AM; 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto.; 9Krembil Research Institute, Toronto.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2023 Sep 01; Vol. 140 (3), pp. 639-647. Date of Electronic Publication: 2023 Sep 01 (Print Publication: 2024).
DOI:	10.3171/2023.6.JNS23171
Abstrakt:	Objective: The use of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of tremor-related disorders and other novel indications has been limited by guidelines advocating treatment of patients with a skull density ratio (SDR) above 0.45 ± 0.05 despite reports of successful outcomes in patients with a low SDR (LSDR). The authors' goal was to retrospectively analyze the sonication strategies, adverse effects, and clinical and imaging outcomes in patients with SDR ≤ 0.4 treated for tremor using MRgFUS. Methods: Clinical outcomes and adverse effects were assessed at 3 and 12 months after MRgFUS. Outcomes and lesion location, volume, and shape characteristics (elongation and eccentricity) were compared between the SDR groups. Results: A total of 102 consecutive patients were included in the analysis, of whom 39 had SDRs ≤ 0.4. No patient was excluded from treatment because of an LSDR, with the lowest being 0.22. Lesioning temperatures (> 52°C) and therapeutic ablations were achieved in all patients. There were no significant differences in clinical outcome, adverse effects, lesion location, and volume between the high SDR group and the LSDR group. SDR was significantly associated with total energy (rho = -0.459, p < 0.001), heating efficiency (rho = 0.605, p < 0.001), and peak temperature (rho = 0.222, p = 0.025). Conclusions: The authors' results show that treatment of tremor in patients with an LSDR using MRgFUS is technically possible, leading to a safe and lasting therapeutic effect. Limiting the number of sonications and adjusting the energy and duration to achieve the required temperature early during the treatment are suitable strategies in LSDR patients.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu