Buongermini Rafael, Bichsel Oliver, Schmidt Franziska Anna, Hajiabadi Mohammed Mehdi, Cabrera-Montes Jorge, Mueller Matthew C, Yang Andrew, Bhatia Anuj, Germann Jürgen, Boutet Alexandre, Lozano Andres M
Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada.
Department of Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Comunidad de Madrid, Spain.
J Neurosurg Case Lessons. 2025 Jul 21;10(3). doi: 10.3171/CASE2525.
MR-guided focused ultrasound (MRgFUS) thalamotomy is a relatively novel technique used to treat essential tremor (ET) and tremor-dominant Parkinson's disease. It is thought to be a safer alternative to other treatments, with no reported cases of major intracranial bleeding to date. However, experience with patients at increased risk of hemorrhage is still limited.
The authors present the case of a successfully treated ET patient with thrombocytopenia who experienced no postprocedural complications, detailing the surgical optimization strategy used. They conducted a systematic review of the literature, focusing on articles addressing MRgFUS in patients with known coagulation disorders. The Embase, Scopus, and MEDLINE databases were queried from their inception to August 20, 2024. Of the 973 screened abstracts, 2 relevant studies were identified. The first study included 40 patients undergoing MRgFUS without interruption of antiplatelet or anticoagulant therapy, while the second was a case report of a patient with von Willebrand disease. Both studies reported satisfactory safety profiles, with no increased incidence of hemorrhagic or other complications.
Although evidence is limited due to the small number of studies and cases, these findings suggest that MRgFUS, with appropriate periprocedural optimization, represents a viable option for patients at heightened risk of intracranial hemorrhage. https://thejns.org/doi/10.3171/CASE2525.
磁共振引导聚焦超声（MRgFUS）丘脑切开术是一种用于治疗特发性震颤（ET）和震颤为主型帕金森病的相对新颖的技术。它被认为是比其他治疗方法更安全的选择，迄今为止尚无重大颅内出血的报道病例。然而，对于出血风险增加的患者，相关经验仍然有限。
作者介绍了一例成功接受治疗的血小板减少症ET患者，该患者术后未出现并发症，并详细说明了所采用的手术优化策略。他们对文献进行了系统回顾，重点关注有关已知凝血障碍患者的MRgFUS的文章。检索了Embase、Scopus和MEDLINE数据库，时间跨度从数据库建立至2024年8月20日。在筛选的973篇摘要中，确定了2项相关研究。第一项研究纳入了40例在未中断抗血小板或抗凝治疗的情况下接受MRgFUS的患者，第二项是1例血管性血友病患者的病例报告。两项研究均报告了令人满意的安全性，出血或其他并发症的发生率没有增加。
尽管由于研究和病例数量较少，证据有限，但这些发现表明，经过适当的围手术期优化，MRgFUS对于颅内出血风险较高的患者是一种可行的选择。https://thejns.org/doi/10.3171/CASE2525
