Gallay Marc N, Moser David, Federau Christian, Jeanmonod Daniel
Center for Ultrasound Functional Neurosurgery, SoniModul, Solothurn, Switzerland.
Institute for Biomedical Engineering, ETH Zürich, University of Zürich, Zurich, Switzerland.
Front Surg. 2019 Jan 24;6:2. doi: 10.3389/fsurg.2019.00002. eCollection 2019.
MR-guided focused ultrasound (MRgFUS) offers new perspectives for safe and efficient lesioning inside the brain. The issue of target coverage remains primordial and sub-optimally addressed or solved in the field of functional neurosurgery. To provide an optimized planning and operative strategy to perform a pallidothalamic tractotomy (PTT) in chronic therapy-resistant Parkinson's disease (PD) with the technology of MRgFUS. Histological sections and maps from 6 human brain hemispheres were analyzed and outlines of the pallidothalamic tract on Myelin-stained sections were drawn and superimposed. We determined a standardized PTT target coverage characterized by 5 to 7 preplanned target lesion sub-units of 1.5 × 1.5 × 3.0 mm, which were placed using focal point displacements and shortest possible times, under thermal dose control. We hereby present our current approach to the MRgFUS PTT on the basis of a histological reappraisal and optimized heat application to the pallidothalamic tract in the H1 field of Forel.
磁共振引导聚焦超声（MRgFUS）为安全、高效地在脑内进行损伤治疗提供了新的视角。在功能神经外科领域，靶点覆盖问题仍然至关重要，且未得到充分解决。本研究旨在利用MRgFUS技术，为慢性治疗抵抗性帕金森病（PD）患者实施苍白球丘脑束切断术（PTT）提供优化的规划和手术策略。分析了6个人脑半球的组织学切片和图谱，并绘制了髓鞘染色切片上苍白球丘脑束的轮廓并进行叠加。我们确定了一种标准化的PTT靶点覆盖方式，其特征为5至7个预先规划的1.5×1.5×3.0毫米的靶点损伤亚单位，这些亚单位在热剂量控制下通过焦点位移和尽可能短的时间放置。在此，我们基于组织学重新评估以及对Forel H1区苍白球丘脑束的优化热应用，展示我们目前对MRgFUS PTT的方法。
