Mendelson Benjamin, Melott Joseph C, Gelman Kate, Khan Abdul Hadi, Bhagwat Aniruddha, Konrad Peter, Memon Adeel A
School of Medicine, West Virginia University, Morgantown, WV, 26505, USA.
Department of Medicine, Jinnah Sindh Medical University, Karachi, 75510, Pakistan.
Neurosurg Rev. 2025 Jun 4;48(1):479. doi: 10.1007/s10143-025-03627-6.
Magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy has been an effective treatment option in the management of various tremor etiologies. The process of targeting the VIM thalamic location relies on indirect atlas/coordinate-based systems using anatomic reference points. With advancing imaging modalities, thalamic structures can be better visualized resulting in additional targeting techniques and improved accuracy.
To identify and evaluate MRgFUS thalamotomy targeting techniques for tremor beyond atlas/coordinate-based systems.
A systematic review was conducted in Embase, Cochrane, and PubMed. Studies including MRgFUS for tremor, targeting methods, and tremor outcomes were included. After review of 297 studies, 13 met inclusion criteria.
All 13 studies used tractography to visualize various combinations of white matter tracts to guide target acquisition. These tracts include the medial lemniscus (ML), corticospinal tract (CST), and the dentatorubrothalamic tracts (DRTT) which was further delineated into the non-decussating (ndDRTT) and a decussating components (dDRTT) by some studies. At least 50% reduction was reported by all studies with paresthesia and gait instability being the most common side effects, although mostly mild and transient.
Advanced targeting via tractography may lead to better outcomes and could broaden the eligibility criteria for MRgFUS. Individualized targeting allows for more precise sonication, potentially reducing the number of sonications needed, improving patient tolerance, making sedation a viable option, and boosting effectiveness, especially in cases of atypical anatomy. To confirm these potential benefits in MRgFUS thalamotomy, standardized trials are definitely needed.
磁共振引导聚焦超声（MRgFUS）丘脑切开术一直是治疗各种震颤病因的有效选择。靶向丘脑腹中间核（VIM）位置的过程依赖于使用解剖学参考点的间接图谱/坐标系统。随着成像方式的不断进步，丘脑结构可以得到更好的可视化，从而产生额外的靶向技术并提高准确性。
识别和评估MRgFUS丘脑切开术在基于图谱/坐标系统之外的震颤靶向技术。
在Embase、Cochrane和PubMed数据库中进行了系统综述。纳入了包括MRgFUS治疗震颤、靶向方法和震颤结果的研究。在对297项研究进行审查后，13项符合纳入标准。
所有13项研究均使用纤维束成像来可视化白质束的各种组合，以指导靶点获取。这些束包括内侧丘系（ML）、皮质脊髓束（CST）和齿状红核丘脑束（DRTT），一些研究进一步将其分为非交叉（ndDRTT）和交叉部分（dDRTT）。所有研究均报告至少有50%的改善，感觉异常和步态不稳是最常见的副作用，不过大多为轻度且短暂。
通过纤维束成像进行的先进靶向可能会带来更好的结果，并可能扩大MRgFUS的适用标准。个体化靶向允许更精确的超声处理，有可能减少所需的超声处理次数，提高患者耐受性，使镇静成为可行的选择，并提高有效性，特别是在解剖结构不典型的情况下。为了证实MRgFUS丘脑切开术中的这些潜在益处，肯定需要进行标准化试验。
