Departments of1Neurosurgery and.
2Department of Neurosurgery, Medstar Georgetown University Hospital.
Neurosurg Focus. 2024 Sep 1;57(3):E6. doi: 10.3171/2024.6.FOCUS24332.
MR-guided focused ultrasound (MRgFUS) is an evolving technology with numerous present and potential applications in pediatric neurosurgery. The aim of this study was to describe the use of MRgFUS, technical challenges, complications, and lessons learned at a single children's hospital.
A retrospective analysis was performed of a prospectively collected database of all pediatric patients undergoing investigational use of MRgFUS for treatment of various neurosurgical pathologies at Children's National Hospital. Treatment details, clinical workflow, and standard operating procedures are described. Patient demographics, procedure duration, and complications were obtained through a chart review of anesthesia and operative reports.
In total, 45 MRgFUS procedures were performed on 14 patients for treatment of diffuse intrinsic pontine glioma (n = 12), low-grade glioma (n = 1), or secondary dystonia (n = 1) between January 2022 and April 2024. The mean age at treatment was 9 (range 5-22) years, and 64% of the patients were male. With increased experience, the total anesthesia time, sonication time, and change in core body temperature during treatment all significantly decreased. Complications affected 4.4% of patients, including 1 case of scalp edema and 1 patient with a postprocedure epidural hematoma. Device malfunction requiring abortion of the procedure occurred in 1 case (2.2%). Technical challenges related to transducer malfunction and sonication errors occurred in 6.7% and 11.1% of cases, respectively, all overcome by subsequent user modifications.
The authors describe the largest series on MRgFUS technical aspects in pediatric neurosurgery at a single institution, comprising 45 total treatments. This study emphasizes potential technical challenges and provides valuable insights into the nuances of its application in pediatric patients.
磁共振引导聚焦超声（MRgFUS）是一种不断发展的技术，在儿科神经外科中有许多目前和潜在的应用。本研究的目的是描述在一家儿童医院使用 MRgFUS 的情况、技术挑战、并发症和经验教训。
对在儿童国家医院接受 MRgFUS 治疗各种神经外科疾病的前瞻性收集的数据库进行了回顾性分析。描述了治疗细节、临床工作流程和标准操作程序。通过对麻醉和手术报告的图表审查，获得了患者人口统计学数据、手术持续时间和并发症。
在 2022 年 1 月至 2024 年 4 月期间，共对 14 名患者的 45 次 MRgFUS 手术进行了治疗，用于治疗弥漫性内在脑桥胶质瘤（n = 12）、低级别胶质瘤（n = 1）或继发性肌张力障碍（n = 1）。治疗时的平均年龄为 9 岁（范围为 5-22 岁），64%的患者为男性。随着经验的增加，总麻醉时间、超声时间和治疗过程中核心体温的变化均显著减少。并发症影响了 4.4%的患者，包括 1 例头皮水肿和 1 例术后硬膜外血肿。1 例（2.2%）因设备故障需要中止手术。分别有 6.7%和 11.1%的病例出现与换能器故障和超声误差相关的技术挑战，所有这些都通过后续的用户修改得到解决。
作者描述了单一机构中儿科神经外科中最大的 MRgFUS 技术方面的系列研究，包括 45 次总治疗。本研究强调了潜在的技术挑战，并提供了对儿科患者应用该技术的细微差别有价值的见解。
