Fiani Brian, Lissak India A, Soula Marisol, Sarhadi Kasra, Shaikh Emad Salman, Baig Aqsa, Farooqui Mudassir, Quadri Syed A
Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.
Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA.
Cureus. 2020 Aug 17;12(8):e9820. doi: 10.7759/cureus.9820.
Functional disorders of the central nervous system (CNS) are diverse in terms of their etiology and symptoms, however, they can be quite debilitating. Many functional neurological disorders can progress to a level where pharmaceuticals and other early lines of treatment can no longer optimally treat the condition, therefore requiring surgical intervention. A variety of stereotactic and functional neurosurgical approaches exist, including deep brain stimulation, implantation, stereotaxic lesions, and radiosurgery, among others. Most techniques are invasive or minimally invasive forms of surgical intervention and require immense precision to effectively modulate CNS circuitry. Focused ultrasound (FUS) is a relatively new, safe, non-invasive neurosurgical approach that has demonstrated efficacy in treating a range of functional neurological diseases. It can function reversibly, through mechanical stimulation causing circuitry changes, or irreversibly, through thermal ablation at low and high frequencies respectively. In preliminary studies, magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) has been shown to have long-lasting treatment effects in several disease types. The technology has been approved by the FDA and internationally for a number of treatment-resistant neurological disorders and currently clinical trials are underway for several other neurological conditions. In this review, the authors discuss the potential applications and emerging role of MRgHIFU in functional neurosurgery in the coming years.
中枢神经系统（CNS）的功能障碍在病因和症状方面多种多样，然而，它们可能会使人非常虚弱。许多功能性神经障碍会发展到药物和其他早期治疗方法无法再对病情进行最佳治疗的程度，因此需要手术干预。存在多种立体定向和功能性神经外科手术方法，包括深部脑刺激、植入、立体定向损伤和放射外科手术等。大多数技术都是侵入性或微创形式的手术干预，需要极高的精度才能有效调节中枢神经系统回路。聚焦超声（FUS）是一种相对较新的、安全的、非侵入性神经外科手术方法，已证明在治疗一系列功能性神经疾病方面有效。它可以通过机械刺激引起回路变化而可逆地发挥作用，或者分别通过低频和高频热消融而不可逆地发挥作用。在初步研究中，磁共振成像引导的高强度聚焦超声（MRgHIFU）已被证明在多种疾病类型中具有持久的治疗效果。该技术已获得美国食品药品监督管理局（FDA）和国际上对多种难治性神经疾病的批准，目前针对其他几种神经疾病的临床试验正在进行中。在这篇综述中，作者讨论了MRgHIFU在未来几年功能性神经外科手术中的潜在应用和新兴作用。
