Qiu Liming, Pomeraniec I Jonathan, Howard Susanna D, Ajmera Sonia, Bagley Linda J, Cajigas Iahn, Kennedy Benjamin C, Halpern Casey H
Department of Neurosurgery, University of Pennsylvania Health System, University of Pennsylvania Perelman School of Medicine, Philadelphia , Pennsylvania , USA.
Department of Radiology, University of Pennsylvania Health System, University of Pennsylvania Perelman School of Medicine, Philadelphia , Pennsylvania , USA.
Oper Neurosurg. 2024 Nov 18;29(2):281-287. doi: 10.1227/ons.0000000000001457.
Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) has revolutionized ablative treatment of essential tremor in recent years. However, limitations in precision targeting may account for suboptimal efficacy and significant side effects. We describe a simple intraprocedural three-dimensional image-guided lesion shaping technique that can improve overall outcomes of MRgFUS for essential tremor and facilitate expansion to novel indications.
A retrospective review of 84 consecutive MRgFUS procedures performed at Pennsylvania Hospital was performed. Comparison of patient demographics, treatment parameters, and clinical outcomes before and after implementation of this protocol was conducted. Further application of this technique in pallidotomy treatments and ablative disconnection of hypothalamic hamartoma are described.
After implementation, the median of total number of sonications (7 vs 9, P = .001), number of therapeutic sonications (3 vs 4, P < .0001), and interval time between the first and last sonication (46:10 vs 68:53 minutes, P = .0004) were significantly reduced. Patients expressed greater satisfaction of treatment (94.1% vs 82.4%, P = .018), greater global impression of change (CGI) (7 vs 6, P = .033), and reduced median number of side effects at 6 months (0 vs 1, P = .026). We also successfully implemented this protocol for novel indications.
Intraprocedural lesion shaping for MRgFUS is a simple and versatile imaging protocol augmentation that improves ablation precision and can improve treatment efficacy and broader neurological application.
近年来，经颅磁共振引导聚焦超声（MRgFUS）彻底改变了特发性震颤的消融治疗。然而，精准靶向的局限性可能导致疗效欠佳和显著的副作用。我们描述了一种简单的术中三维图像引导病变塑形技术，该技术可改善MRgFUS治疗特发性震颤的总体效果，并有助于拓展至新的适应症。
对宾夕法尼亚医院连续进行的84例MRgFUS手术进行回顾性分析。比较该方案实施前后患者的人口统计学特征、治疗参数和临床结果。还描述了该技术在苍白球切开术治疗和下丘脑错构瘤消融离断术中的进一步应用。
实施该方案后，总超声次数中位数（7次对9次，P = 0.001）、治疗性超声次数（3次对4次，P < 0.0001）以及首次与末次超声之间的间隔时间（46:10对68:53分钟，P = 0.0004）均显著减少。患者对治疗的满意度更高（94.1%对82.4%，P = 0.018），整体变化印象（CGI）更好（7分对6分，P = 0.033），6个月时副作用中位数减少（0次对1次，P = 0.026）。我们还成功将该方案应用于新的适应症。
MRgFUS术中病变塑形是一种简单且通用的成像方案增强方法，可提高消融精度，改善治疗效果，并拓展更广泛的神经学应用。
