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革命性的脑介入治疗:histotripsy 的多方面潜力

Revolutionizing brain interventions: the multifaceted potential of histotripsy.

机构信息

Norfolk and Norwich University Hospital, Norwich, UK.

Independant researcher, Milan, Italy.

出版信息

Neurosurg Rev. 2024 Mar 21;47(1):124. doi: 10.1007/s10143-024-02353-9.

Abstract

Histotripsy, a non-thermal ultrasound technique, holds significant promise in various applications within the realm of brain interventions. While its use for treating brain tumors is somewhat limited, focused ultrasound technology has been extensively investigated for a wide range of purposes within the brain, including disrupting the blood-brain barrier, supporting immunotherapy, addressing conditions like essential tremor, Parkinson's disease, Alzheimer's disease, epilepsy, and neuropathic pain. Research findings indicate that histotripsy can reduce tumor cells with fewer pulses, minimizing the risk of bleeding and cellular injury. The use of MRI sequences such as T2 and T2* enhances the evaluation of the effects of histotripsy treatment, facilitating non-invasive assessment of treated areas. Furthermore, histotripsy displays promise in creating precise brain lesions with minimal edema and inflammation, particularly in porcine models, suggesting considerable progress in the treatment of brain lesions. Moreover, studies confirm its feasibility, safety, and effectiveness in treating intracerebral hemorrhage by safely liquefying clots without causing significant harm to surrounding brain tissue., opening exciting possibilities for clinical applications. The development of transcranial MR-guided focused ultrasound systems based on histotripsy represents a significant breakthrough in overcoming the limitations associated with thermal ablation techniques. Histotripsy's ability to efficiently liquefy clots, minimize skull heating, and target shallow lesions near the skull establishes it as a promising alternative for various brain treatments. In conclusion, histotripsy offers diverse potential in the field of brain interventions, encompassing applications ranging from tumor treatment to the management of intracerebral hemorrhage. While challenges such as accurate monitoring and differentiation of treatment effects persist, ongoing research efforts and technological advancements continue to expand the role of histotripsy in both neurology and neurosurgery.

摘要

超声空化爆破(Histotripsy)作为一种非热超声技术,在脑介入领域的各种应用中具有很大的应用潜力。虽然它在治疗脑肿瘤方面的应用有些受限,但聚焦超声技术已被广泛研究用于大脑的多种用途,包括破坏血脑屏障、支持免疫疗法、治疗特发性震颤、帕金森病、阿尔茨海默病、癫痫和神经痛等疾病。研究结果表明,超声空化爆破可以用更少的脉冲来减少肿瘤细胞,从而最大程度地降低出血和细胞损伤的风险。使用 T2 和 T2*等 MRI 序列可以增强对超声空化爆破治疗效果的评估,便于对治疗区域进行非侵入性评估。此外,超声空化爆破在创建具有最小水肿和炎症的精确脑损伤方面显示出潜力,尤其是在猪模型中,这表明在治疗脑损伤方面取得了相当大的进展。此外,研究证实了它在通过安全地液化血栓而不对周围脑组织造成重大伤害的情况下治疗脑出血的可行性、安全性和有效性,为临床应用开辟了令人兴奋的可能性。基于超声空化爆破的颅外 MR 引导聚焦超声系统的开发是克服与热消融技术相关的限制的重大突破。超声空化爆破能够有效地液化血栓、最小化颅骨加热并靶向颅骨附近的浅层病变,使其成为各种脑治疗的有前途的替代方法。总之,超声空化爆破在脑介入领域具有广泛的应用潜力,涵盖了从肿瘤治疗到颅内出血管理等多种应用。尽管存在准确监测和治疗效果区分等挑战,但持续的研究努力和技术进步继续扩大了超声空化爆破在神经学和神经外科学中的作用。

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