Baek Hongchae, Chen Jacqueline, Lockwood Daniel, Obusez Emmanuel, Poturalski Matthew, Nagel Sean J, Jones Stephen E
Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Oper Neurosurg (Hagerstown). 2023 Jun 1;24(6):641-650. doi: 10.1227/ons.0000000000000638. Epub 2023 Feb 23.
Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is used to treat essential tremor and tremor-dominant Parkinson disease. Feedback is collected throughout the procedure to verify the location of the target and completeness of response; however, variability in clinical judgments may underestimate or overestimate treatment response.
To objectively quantify joint motion after each sonication using accelerometers secured to the contralateral upper extremity in an effort to optimize MRgFUS treatment.
Before the procedure, 3 accelerometers were secured to the patient's arm, forearm, and index finger. Throughout the procedure, tremor motion was regularly recorded during postural and kinetic tremor testing and individual joint angle measures were modeled. The joint angle from each accelerometer was compared with baseline measurements to assess changes in angles. Subsequent adjustments to the target location and sonication energy were made at the discretion of the neurosurgeon and neuroradiologist.
Intraoperative accelerometer measurements of hand tremor from 18 patients provided quantified data regarding joint angle reduction: 87.3%, 94.2%, and 86.7% for signature writing, spiral drawing, and line drawing tests, respectively. Target adjustment based on accelerometer monitoring of the angle at each joint added substantial value toward achieving optimal tremor reduction.
Real-time accelerometer recordings collected during MRgFUS thalamotomy offered objective quantification of changes in joint angle after each sonication, and these findings were consistent with clinical judgments of tremor response. These results suggest that this technique could be used for fine adjustment of the location of sonication energy and number of sonications to consistently achieve optimal tremor reduction.
磁共振引导聚焦超声丘脑切开术用于治疗特发性震颤和震颤为主型帕金森病。在整个手术过程中收集反馈信息，以核实靶点位置和反应的完整性；然而，临床判断的变异性可能会低估或高估治疗反应。
使用固定于对侧上肢的加速度计客观量化每次超声处理后的关节运动，以优化磁共振引导聚焦超声治疗。
在手术前，将3个加速度计固定于患者的手臂、前臂和食指。在整个手术过程中，在姿势性和动作性震颤测试期间定期记录震颤运动，并对各个关节角度测量值进行建模。将每个加速度计测得的关节角度与基线测量值进行比较，以评估角度变化。随后，神经外科医生和神经放射科医生酌情对靶点位置和超声能量进行调整。
对18例患者手部震颤的术中加速度计测量提供了关于关节角度减小的量化数据：在签名书写、螺旋线绘制和直线绘制测试中，关节角度减小分别为87.3%、94.2%和86.7%。基于对每个关节角度的加速度计监测进行靶点调整，对实现最佳震颤减轻有很大价值。
在磁共振引导聚焦超声丘脑切开术期间收集的实时加速度计记录提供了每次超声处理后关节角度变化的客观量化，这些结果与震颤反应的临床判断一致。这些结果表明，该技术可用于超声能量位置和超声次数的精细调整，以持续实现最佳震颤减轻。
