Fishman Paul S, Frenkel Victor
Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
J Cent Nerv Syst Dis. 2017 Jun 6;9:1179573517705670. doi: 10.1177/1179573517705670. eCollection 2017.
Although the use of ultrasound as a potential therapeutic modality in the brain has been under study for several decades, relatively few neuroscientists or neurologists are familiar with this technology. Stereotactic brain lesioning had been widely used as a treatment for medically refractory patients with essential tremor (ET), Parkinson disease (PD), and dystonia but has been largely replaced by deep brain stimulation (DBS) surgery, with advantages both in safety and efficacy. However, DBS is associated with complications including intracerebral hemorrhage, infection, and hardware malfunction. The occurrence of these complications has spurred interest in less invasive stereotactic brain lesioning methods including magnetic resonance imaging-guided high intensity-focused ultrasound (FUS) surgery. Engineering advances now allow sound waves to be targeted noninvasively through the skull to a brain target. High intensities of sonic energy can create a coagulation lesion similar to that of older radiofrequency stereotactic methods, but without opening the skull, recent Food and Drug Administration approval of unilateral thalamotomy for treatment of ET. Clinical studies of stereotactic FUS for aspects of PD are underway. Moderate intensity, pulsed FUS has also demonstrated the potential to safely open the blood-brain barrier for localized delivery of therapeutics including proteins, genes, and cell-based therapy for PD and related disorders. The goal of this review is to provide basic and clinical neuroscientists with a level of understanding to interact with medical physicists, biomedical engineers, and radiologists to accelerate the application of this powerful technology to brain disease.
尽管将超声作为一种潜在的脑部治疗方式进行研究已有数十年，但相对而言，很少有神经科学家或神经科医生熟悉这项技术。立体定向脑毁损术曾被广泛用于治疗药物难治性特发性震颤（ET）、帕金森病（PD）和肌张力障碍患者，但在很大程度上已被深部脑刺激（DBS）手术所取代，DBS手术在安全性和有效性方面均具有优势。然而，DBS会引发包括脑出血、感染和硬件故障在内的并发症。这些并发症的出现激发了人们对侵入性较小的立体定向脑毁损术方法的兴趣，包括磁共振成像引导的高强度聚焦超声（FUS）手术。工程技术的进步现在使声波能够通过颅骨无创地靶向脑部目标。高强度的声能可以产生类似于较旧的射频立体定向方法的凝固性损伤，但无需打开颅骨，最近美国食品药品监督管理局批准了用于治疗ET的单侧丘脑切开术。针对PD方面的立体定向FUS的临床研究正在进行中。中等强度的脉冲FUS也已证明有潜力安全地打开血脑屏障，以便局部递送包括蛋白质、基因以及用于治疗PD和相关疾病的细胞疗法等治疗药物。这篇综述的目的是让基础和临床神经科学家对该技术有一定程度的了解，以便与医学物理学家、生物医学工程师和放射科医生进行交流，从而加速这项强大技术在脑部疾病中的应用。
