Piper Rory J, Hughes Mark A, Moran Carmel M, Kandasamy Jothy
a College of Medicine and Veterinary Medicine , University of Edinburgh , Edinburgh , UK ;
b Department of Clinical Neuroscience , Western General Hospital , Edinburgh , UK ;
Br J Neurosurg. 2016 Jun;30(3):286-93. doi: 10.3109/02688697.2016.1173189. Epub 2016 Apr 22.
Focused ultrasound (FUS) is an incision-less intervention that is a Food and Drug Association (FDA) approved surgical treatment for various pathologies including uterine fibroids and bone metastases. Recent advances in magnetic resonance imaging thermometry and ability to use FUS across the intact calvarium have re-opened interest in the use of FUS in the treatment of neurological diseases. FUS currently has a European CE mark for use in movement disorders. However, it shows potential in the treatment of other neuropathologies including tumours and as a lesional tool in epilepsy. FUS may exert its therapeutic effect through thermal or mechanical fragmentation of intracranial lesions, or by enhancing delivery of pharmaceutical agents across the blood-brain barrier. In this review, we summarise the mechanisms, clinical applications and potential future of FUS for the treatment of neurological disease. We have searched for and described the recently completed and on-going clinical trials investigating FUS for the treatment of neurological disorders. We identified phase one trials investigating utility of FUS in: movement disorders (including essential tremor and Parkinson's disease), chronic pain, obsessive-compulsive disorder and cerebral tumours. Current literature also reports pre-clinical work exploring utility in epilepsy, neurodegenerative conditions (such as Alzheimer's disease) and thrombolysis. Safety and early efficacy data are now emerging, suggesting that transcalvarial FUS is a feasible and safe intervention. Further evidence is required to determine whether FUS is an effective alternative in comparison to current neurosurgical interventions. The cost of requisite hardware is currently a barrier to widespread uptake in UK neurosurgical centres.
聚焦超声（FUS）是一种无需开刀的干预手段，是美国食品药品监督管理局（FDA）批准用于治疗包括子宫肌瘤和骨转移瘤等多种病症的外科治疗方法。磁共振成像温度测量技术的最新进展以及在完整颅骨上使用FUS的能力，重新引发了人们对FUS用于治疗神经疾病的兴趣。FUS目前在欧洲有用于治疗运动障碍的CE标志。然而，它在治疗包括肿瘤在内的其他神经病理学疾病以及作为癫痫的病灶治疗工具方面显示出潜力。FUS可能通过对颅内病变进行热或机械破碎，或通过增强药物穿过血脑屏障的递送发挥其治疗作用。在本综述中，我们总结了FUS治疗神经疾病的机制、临床应用及潜在的未来发展。我们搜索并描述了最近完成的和正在进行的研究FUS治疗神经疾病的临床试验。我们确定了研究FUS在以下方面效用的一期试验：运动障碍（包括特发性震颤和帕金森病）、慢性疼痛、强迫症和脑肿瘤。当前文献也报道了在癫痫、神经退行性疾病（如阿尔茨海默病）和溶栓方面探索效用的临床前研究工作。安全性和早期疗效数据正在出现，表明经颅骨FUS是一种可行且安全的干预手段。需要进一步的证据来确定与当前神经外科干预相比，FUS是否是一种有效的替代方法。所需硬件的成本目前是英国神经外科中心广泛采用该技术的一个障碍。
