1
|
Hashida M, Maesawa S, Kato S, Nakatsubo D, Tsugawa T, Torii J, Tanei T, Ishizaki T, Mutoh M, Ito Y, Tsuboi T, Mizuno S, Suzuki M, Wakabayashi T, Katsuno M, Saito R. Outcomes and Prognostic Factors of Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Essential Tremor at 2-year Follow-up. Neurol Med Chir (Tokyo) 2024; 64:137-146. [PMID: 38355128 PMCID: PMC11099165 DOI: 10.2176/jns-nmc.2023-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an effective treatment for essential tremor (ET). However, its long-term outcomes and prognostic factors remain unclear. This study aimed to retrospectively investigate 38 patients with ET who underwent MRgFUS thalamotomy and were followed up for >2 years. The improvement in tremor was evaluated using the Clinical Rating Scale for Tremor (CRST). Adverse events were documented, and correlations with factors, such as skull density ratio (SDR), maximum mean temperature (T-max), and lesion size, were examined. Furthermore, the outcomes were compared between two groups, one that met the cutoff values, which was previously reported (preoperative CRST-B ≤ 25, T-max ≥ 52.5°C, anterior-posterior size of lesion ≥ 3.9 mm, superior-inferior [SI] size of lesion > 5.5 mm), and the other that did not. The improvement rate was 59.4% on average at the 2-year follow-up. Adverse events, such as numbness (15.8%), dysarthria (10.5%), and lower extremity weakness (2.6%), were observed even after 2 years, although these were mild. The factors correlated with tremor improvement were the T-max and SI size of the lesion (p < 0.05), whereas the SDR showed no significance. Patients who met the aforementioned cutoff values demonstrated a 69.8% improvement at the 2-year follow-up, whereas others showed a 43.6% improvement (p < 0.05). In conclusion, MRgFUS is effective even after 2 years. The higher the T-max and the larger the lesion size, the better the tremor control. Previously reported cutoff values clearly predict the 2-year prognosis, indicating the usefulness of MRgFUS.
Collapse
Affiliation(s)
- Miki Hashida
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
- Brain and Mind Research Center, Nagoya University
| | - Sachiko Kato
- Focused Ultrasound Surgery Center, Nagoya Kyoritsu Hospital
| | | | | | - Jun Torii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Tomotaka Ishizaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Manabu Mutoh
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Yoshiki Ito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Takashi Tsuboi
- Department of Neurology, Nagoya University Graduate School of Medicine
| | - Satomi Mizuno
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center
| | - Masashi Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine
- Department of Clinical Laboratory, Nagoya University Hospital
| | | | - Masahisa Katsuno
- Brain and Mind Research Center, Nagoya University
- Department of Neurology, Nagoya University Graduate School of Medicine
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
- Brain and Mind Research Center, Nagoya University
| |
Collapse
|
2
|
Morabito R, Cammaroto S, Militi A, Smorto C, Anfuso C, Lavano A, Tomasello F, Di Lorenzo G, Brigandì A, Sorbera C, Bonanno L, Ielo A, Vatrano M, Marino S, Cacciola A, Cerasa A, Quartarone A. The Role of Treatment-Related Parameters and Brain Morphology in the Lesion Volume of Magnetic-Resonance-Guided Focused Ultrasound Thalamotomy in Patients with Tremor-Dominant Neurological Conditions. Bioengineering (Basel) 2024; 11:373. [PMID: 38671794 PMCID: PMC11047844 DOI: 10.3390/bioengineering11040373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE To determine the best predictor of lesion volume induced by magnetic resonance (MR)-guided focused ultrasound (MRgFUS) thalamotomy in patients with tremor-dominant symptoms in Parkinson's disease (PD) and essential tremor (ET) patients. METHODS Thirty-six neurological patients with medication-refractory tremor (n°19 PD; n°17 ET) were treated using a commercial MRgFUS brain system (Exablate Neuro 4000, Insightec) integrated with a 1.5 T MRI unit (Sigma HDxt; GE Medical System). Linear regression analysis was used to determine how the demographic, clinical, radiological (Fazekas scale), volumetric (total GM/WM/CSF volume, cortical thickness), and MRgFUS-related parameters [Skull Density Ratio (SDR), n° of transducer elements, n° of sonications, skull area, maximal energy delivered (watt), maximal power delivered (joule), maximal sonication time delivered, maximal mean temperature reached (T°C_max), accumulated thermal dose (ATD)] impact on ventral intermediate (VIM)-thalamotomy-related 3D volumetric lesions of necrosis and edema. RESULTS The VIM thalamotomy was clinically efficacious in improving the tremor symptoms of all the patients as measured at 1 week after treatment. Multiple regression analysis revealed that T°C_max and n° of transducer elements were the best predictors of the necrosis and edema volumes. Moreover, total WM volume also predicted the size of necrosis. CONCLUSIONS Our study provides new insights into the clinical MRgFUS procedures that can be used to forecast brain lesion size and improve treatment outcomes.
Collapse
Affiliation(s)
- Rosa Morabito
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Simona Cammaroto
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Annalisa Militi
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Chiara Smorto
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Carmelo Anfuso
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Angelo Lavano
- Mater Domini University Hospital, Magna Graecia University, 88100 Catanzaro, Italy;
| | | | - Giuseppe Di Lorenzo
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Amelia Brigandì
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Chiara Sorbera
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Lilla Bonanno
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Augusto Ielo
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | | | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| | - Alberto Cacciola
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98122 Messina, Italy;
| | - Antonio Cerasa
- S. Anna Institute, 88900 Crotone, Italy;
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Arcavacata, Italy
| | - Angelo Quartarone
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (R.M.); (S.C.); (A.M.); (C.S.); (C.A.); (A.B.); (C.S.); (L.B.); (A.I.); (S.M.)
| |
Collapse
|
3
|
He X, Oshino S, Hosomi K, Kanemoto M, Tani N, Kishima H. Characteristics of Pain During MRI-Guided Focused Ultrasound Thalamotomy. Neurosurgery 2023; 93:358-365. [PMID: 36861986 PMCID: PMC10319367 DOI: 10.1227/neu.0000000000002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/22/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging-guided focused ultrasound (MRgFUS) has become popular as an incisionless mode of neurosurgical treatment. However, head pain during sonication is common and its pathophysiology remains poorly understood. OBJECTIVE To explore the characteristics of head pain occurring during MRgFUS thalamotomy. METHODS Our study comprised 59 patients who answered questions about the pain they experienced during unilateral MRgFUS thalamotomy. The location and features of pain were investigated using a questionnaire including the numerical rating scale (NRS) to estimate maximum pain intensity and the Japanese version of the Short Form of McGill Pain Questionnaire 2 to evaluate the quantitative and qualitative dimensions of pain. Several clinical factors were investigated for possible correlation with pain intensity. RESULTS Forty-eight patients (81%) reported sonication-related head pain, and the degree of pain was severe (NRS score ≥ 7) in 39 patients (66%). The distribution of sonication-related pain was "localized" in 29 (49%) and "diffuse" in 16 (27%); the most frequent location was the "occipital" region. The pain features most frequently reported were those in the "affective" subscale of the Short Form of McGill Pain Questionnaire 2. Patients with diffuse pain had a higher NRS score and lower skull density ratio than did patients with localized pain. The NRS score negatively correlated with tremor improvement at 6 months post-treatment. CONCLUSION Most patients in our cohort experienced pain during MRgFUS. The distribution and intensity of pain varied according to the skull density ratio, indicating that the pain might have had different origins. Our results may contribute to the improvement of pain management during MRgFUS.
Collapse
Affiliation(s)
- Xin He
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Hosomi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Manabu Kanemoto
- Department of Neurosurgery, Saito Yukoukai Hospital, Ibaraki, Osaka, Japan
| | - Naoki Tani
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
4
|
Yuen J, Goyal A, Kaufmann TJ, Jackson LM, Miller KJ, Klassen BT, Dhawan N, Lee KH, Lehman VT. Comparison of the impact of skull density ratio with alternative skull metrics on magnetic resonance-guided focused ultrasound thalamotomy for tremor. J Neurosurg 2023; 138:50-57. [PMID: 35901729 DOI: 10.3171/2022.5.jns22350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/12/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE One of the key metrics that is used to predict the likelihood of success of MR-guided focused ultrasound (MRgFUS) thalamotomy is the overall calvarial skull density ratio (SDR). However, this measure does not fully predict the sonication parameters that would be required or the technical success rates. The authors aimed to assess other skull characteristics that may also contribute to technical success. METHODS The authors retrospectively studied consecutive patients with essential tremor who were treated by MRgFUS at their center between 2017 and 2021. They evaluated the correlation between the different treatment parameters, particularly maximum power and energy delivered, with a range of patients' skull metrics and demographics. Machine learning algorithms were applied to investigate whether sonication parameters could be predicted from skull density metrics alone and whether including combined local transducer SDRs with overall calvarial SDR would increase model accuracy. RESULTS A total of 62 patients were included in the study. The mean age was 77.1 (SD 9.2) years, and 78% of treatments (49/63) were performed in males. The mean SDR was 0.51 (SD 0.10). Among the evaluated metrics, SDR had the highest correlation with the maximum power used in treatment (ρ = -0.626, p < 0.001; proportion of local SDR values ≤ 0.8 group also had ρ = +0.626, p < 0.001) and maximum energy delivered (ρ = -0.680, p < 0.001). Machine learning algorithms achieved a moderate ability to predict maximum power and energy required from the local and overall SDRs (accuracy of approximately 80% for maximum power and approximately 55% for maximum energy), and high ability to predict average maximum temperature reached from the local and overall SDRs (approximately 95% accuracy). CONCLUSIONS The authors compared a number of skull metrics against SDR and showed that SDR was one of the best indicators of treatment parameters when used alone. In addition, a number of other machine learning algorithms are proposed that may be explored to improve its accuracy when additional data are obtained. Additional metrics related to eventual sonication parameters should also be identified and explored.
Collapse
Affiliation(s)
- Jason Yuen
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Abhinav Goyal
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Kai J Miller
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Kendall H Lee
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Vance T Lehman
- 4Department of Radiology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
5
|
Yamamoto K, Sarica C, Loh A, Vetkas A, Samuel N, Milano V, Zemmar A, Germann J, Cheyuo C, Boutet A, Elias GJ, Ito H, Taira T, Lozano AM. Magnetic resonance-guided focused ultrasound for the treatment of tremor. Expert Rev Neurother 2022; 22:849-861. [PMID: 36469578 DOI: 10.1080/14737175.2022.2147826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging treatment for tremor and other movement disorders. An incisionless therapy, it is becoming increasingly common worldwide. However, given MRgFUS' relative novelty, there remain limited data on its benefits and adverse effects. AREAS COVERED We review the current state of evidence of MRgFUS for tremor, highlight its challenges, and discuss future perspectives. EXPERT OPINION Essential tremor (ET) has been the major indication for MRgFUS since a milestone randomized controlled trial (RCT) in 2016, with substantial evidence attesting to the efficacy and acceptable safety profile of this treatment. Patients with other tremor etiologies are also being treated with MRgFUS, with studies - including an RCT - suggesting parkinsonian tremor in particular responds well to this intervention. Additionally, targets other than the ventral intermediate nucleus, such as the subthalamic nucleus and internal segment of the globus pallidus, have been reported to improve parkinsonian symptoms beyond tremor, including rigidity and bradykinesia. Although MRgFUS is encumbered by certain unique technical challenges, it nevertheless offers significant advantages compared to alternative neurosurgical interventions for tremor. The fast-growing interest in this treatment modality will likely lead to further scientific and technological advancements that could optimize and expand its therapeutic potential.
Collapse
Affiliation(s)
- Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Artur Vetkas
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.,Department of Neurosurgery, School of Medicine, University of Tartu, Estonia
| | - Nardin Samuel
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Vanessa Milano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, School of Medicine, KY, USA.,Department of Neurosurgery, Henan University People's Hospital, Henan University School of Medicine, China
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | - Gavin Jb Elias
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Hisashi Ito
- Department of Neurology, Shonantobu General Hospital, Japan.,Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Mensah-Brown KG, Yang AI, Hitti FL, Henry L, Heman-Ackah SM, Chaibainou H, Baltuch GH. Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor Under General Anesthesia: Technical Note. Oper Neurosurg (Hagerstown) 2022; 22:255-260. [PMID: 35147587 DOI: 10.1227/ons.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an incisionless therapy for the treatment of medication-resistant essential tremor. Although its safety and efficacy has been demonstrated, MRgFUS is typically performed with the patient awake, with intraprocedural neurological assessments to guide lesioning. OBJECTIVE To report the first case of MRgFUS thalamotomy under general anesthesia in a patient whose medical comorbidities prohibit him from being in a supine position without a secured airway. METHODS The dentatorubrothalamic tract was directly targeted. Two sonications reaching lesional temperatures (≥54°C) were delivered without any complications. RESULTS Lesioning was confirmed on intraoperative magnetic resonance imaging, and the patient experienced 89% improvement in his tremor postoperatively. CONCLUSION This demonstrates the safety and feasibility of MRgFUS thalamotomy under general anesthesia without the benefit of intraprocedural neurological assessments.
Collapse
Affiliation(s)
- Kobina G Mensah-Brown
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frederick L Hitti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Sabrina M Heman-Ackah
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hanane Chaibainou
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gordon H Baltuch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Yamamoto K, Lozano AM, Fasano A. Commentary: Feasibility of Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor in the Setting of Prior Craniotomy. Oper Neurosurg (Hagerstown) 2022; 22:e147-e149. [PMID: 35030144 DOI: 10.1227/ons.0000000000000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada.,Krembil Research Institute, Toronto, Canada
| | - Alfonso Fasano
- Krembil Research Institute, Toronto, Canada.,Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Canada
| |
Collapse
|
8
|
Segar DJ, Lak AM, Lee S, Harary M, Chavakula V, Lauro P, McDannold N, White J, Cosgrove GR. Lesion location and lesion creation affect outcomes after focused ultrasound thalamotomy. Brain 2021; 144:3089-3100. [PMID: 34750621 DOI: 10.1093/brain/awab176] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/13/2021] [Accepted: 04/05/2021] [Indexed: 11/13/2022] Open
Abstract
MRI-guided focused ultrasound thalamotomy has been shown to be an effective treatment for medication refractory essential tremor. Here, we report a clinical-radiological analysis of 123 cases of MRI-guided focused ultrasound thalamotomy, and explore the relationships between treatment parameters, lesion characteristics and outcomes. All patients undergoing focused ultrasound thalamotomy by a single surgeon were included. The procedure was performed as previously described, and patients were followed for up to 1 year. MRI was performed 24 h post-treatment, and lesion locations and volumes were calculated. We retrospectively evaluated 118 essential tremor patients and five tremor-dominant Parkinson's disease patients who underwent thalamotomy. At 24 h post-procedure, tremor abated completely in the treated hand in 81 essential tremor patients. Imbalance, sensory disturbances and dysarthria were the most frequent acute adverse events. Patients with any adverse event had significantly larger lesions, while inferolateral lesion margins were associated with a higher incidence of motor-related adverse events. Twenty-three lesions were identified with irregular tails, often extending into the internal capsule; 22 of these patients experienced at least one adverse event. Treatment parameters and lesion characteristics changed with increasing surgeon experience. In later cases, treatments used higher maximum power (normalized to skull density ratio), accelerated more quickly to high power, and delivered energy over fewer sonications. Larger lesions were correlated with a rapid rise in both power delivery and temperature, while increased oedema was associated with rapid rise in temperature and the maximum power delivered. Total energy and total power did not significantly affect lesion size. A support vector regression was trained to predict lesion size and confirmed the most valuable predictors of increased lesion size as higher maximum power, rapid rise to high-power delivery, and rapid rise to high tissue temperatures. These findings may relate to a decrease in the energy efficiency of the treatment, potentially due to changes in acoustic properties of skull and tissue at higher powers and temperatures. We report the largest single surgeon series of focused ultrasound thalamotomy to date, demonstrating tremor relief and adverse events consistent with reported literature. Lesion location and volume impacted adverse events, and an irregular lesion tail was strongly associated with adverse events. High-power delivery early in the treatment course, rapid temperature rise, and maximum power were dominant predictors of lesion volume, while total power, total energy, maximum energy and maximum temperature did not improve prediction of lesion volume. These findings have critical implications for treatment planning in future patients.
Collapse
Affiliation(s)
- David J Segar
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Asad M Lak
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shane Lee
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Maya Harary
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Vamsidhar Chavakula
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Lauro
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Nathan McDannold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason White
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Maesawa S, Nakatsubo D, Tsugawa T, Kato S, Shibata M, Takai S, Torii J, Ishizaki T, Wakabayashi T, Saito R. Techniques, Indications, and Outcomes in Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Tremor. Neurol Med Chir (Tokyo) 2021; 61:629-639. [PMID: 34470990 PMCID: PMC8592814 DOI: 10.2176/nmc.ra.2021-0187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Magnetic resonance (MR)-guided focused ultrasound surgery (MRgFUS) is the latest minimally invasive stereotactic procedure, and thalamotomy using this novel modality has demonstrated its effectiveness and safety, especially for patients with essential tremor (ET) and Parkinson's disease (PD). In Japan, the application of MRgFUS to treat ET and PD has recently been covered by health insurance. Technically, the transducer with 1024 elements emits ultrasound beams, which are then focused on the target with a phase control, resulting in optimal ablation by thermal coagulation. The technical advantages of MRgFUS are continuous intraoperative monitoring of clinical symptoms and MR images and fine adjustment of the target by the steering function. Postoperative tremor control is compatible with other modalities, although long-term follow-up is necessary. The adverse effects are usually transient and acceptable. Prognostic factors for good tremor control include high temperature and large lesion size. A high skull density ratio is a factor to achieve high temperature and large lesioning, but it may not be necessary and sufficient for clinical outcomes. For patients with advanced symptoms such as bilateral tremor or head/neck tremor, deep brain stimulation may be recommended because of the adjustability of stimulation and the possibility of bilateral treatment. Patients have high expectations of MRgFUS because of its non-invasiveness. To perform this treatment safely and effectively, physicians need to understand the technological aspects, the physiological principles. To choose the appropriate modality, physicians also should recognize the clinical advantages and disadvantages of MRgFUS compared to other modalities.
Collapse
Affiliation(s)
- Satoshi Maesawa
- Brain and Mind Research Center, Nagoya University
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Daisuke Nakatsubo
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
- Radiosurgery and Focused Ultrasound Surgery Center, Nagoya Kyoritsu Hospital
| | - Takahiko Tsugawa
- Radiosurgery and Focused Ultrasound Surgery Center, Nagoya Kyoritsu Hospital
| | - Sachiko Kato
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
- Radiosurgery and Focused Ultrasound Surgery Center, Nagoya Kyoritsu Hospital
| | - Masashi Shibata
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
- Radiosurgery and Focused Ultrasound Surgery Center, Nagoya Kyoritsu Hospital
| | - Sou Takai
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Jun Torii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Tomotaka Ishizaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
- Department of Neurosurgery, Kainan Hospital
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
- Radiosurgery and Focused Ultrasound Surgery Center, Nagoya Kyoritsu Hospital
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| |
Collapse
|
10
|
Yang AI, Hitti FL, Alabi OO, Joshi D, Chaibainou H, Henry L, Clanton R, Baltuch GH. Patient-specific effects on sonication heating efficiency during magnetic resonance-guided focused ultrasound thalamotomy. Med Phys 2021; 48:6588-6596. [PMID: 34532858 DOI: 10.1002/mp.15239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE During magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for refractory tremor, high temperatures must be achieved and sustained for tissue necrosis. We assessed the impact of both patient-specific as well as procedure-related factors on the efficiency of acoustic energy transfer, or heating efficiency (HE). METHODS Retrospective analysis of 92 consecutive patients (857 sonications) with essential tremor or tremor-dominant Parkinson's disease treated at a single institution. Temperature elevations at the target were measured for each sonication with MR thermometry. HE of each sonication was defined as the ratio of peak temperature elevation and the delivered energy. HE was analyzed with respect to patient skull features (area, thickness, skull density ratio [SDR]), computed from CT scans, as well as demographic and clinical variables (age, sex, diagnosis, and duration of symptoms). RESULTS Across the full range of sonication energies that can be delivered with current devices (up to 36 kJ), average sonication HE was diminished in patients with lower SDR. In individual subjects, there was a progressive loss in HE as sonication energy was titrated up throughout the course of treatment, with a more rapid decline in patients with higher SDR. This energy-dependent loss in HE was not related to procedural factors, namely, the number of previous sonications, or the cumulative energy deposited during previous sonications. In contrast to SDR, neither skull area nor thickness was an independent predictor of average HE or the rate of its decline with increasing energies. In 11% of patients, all of whom with SDR < 0.45, sonication HE fell below the threshold to reach 54°C even with delivery of maximum energy. In contrast, temperatures ≥ 50°C could be obtained in all but one patient. CONCLUSIONS SDR is predictive of sonication HE, and determines patient-specific limits on the magnitude of temperature elevation that can be achieved with current devices. These data inform strategies for predictable lesioning in MRgFUS thalamotomy.
Collapse
Affiliation(s)
- Andrew I Yang
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frederick L Hitti
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Opeyemi O Alabi
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Disha Joshi
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hanane Chaibainou
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Gordon H Baltuch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
11
|
Tommasino E, Bruno F, Catalucci A, Varrassi M, Sucapane P, Cerone D, Pistoia F, Di Cesare E, Barile A, Ricci A, Marini C, Masciocchi C, Splendiani A. Prognostic value of brain tissues' volumes in patients with essential tremor treated with MRgFUS thalamotomy. J Clin Neurosci 2021; 92:33-38. [PMID: 34509258 DOI: 10.1016/j.jocn.2021.07.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/08/2021] [Accepted: 07/25/2021] [Indexed: 01/05/2023]
Abstract
MRgFUS Vim thalamotomy is a novel, effective, minimally invasive therapeutic option for patients with essential tremor (ET). Among the selection criteria, some parameters related to the patient's anatomy, such as the skull density ratio (SDR), are well recognized. The role of brain tissue interposed between the target and the ultrasound transducers has never been explored. Therefore, the purpose of our study was to evaluate the correlation and the possible predictive value between brain tissue volumes (grey matter - GM, white matter - WM, and cerebrospinal fluid - CSF) and several treatment-related variables (periprocedural parameters, MRI imaging findings, and the clinical outcome). We analysed data from thirty ET patients previously submitted to MRgFUS thalamotomy. Pre-treatment images were automatically segmented in sopra-tentorial (ST) WM, GM, and CSF using SPM 12. The most significant findings were a positive correlation of the ST-GM with the Accumulated Thermal Dose (ATD) (p < 0,001) and a negative correlation of the ATD temperature with ST-CSF and ST-TIV (p < 0,001). Ultrasound propagation speed is lower in fluids than brain tissues. Also, WM has an attenuation rate of 1.5 higher than the GM. Therefore, the difference in the ATD may be explained by the different acoustic properties of normal brain tissues interposed between the transducers and the VIM.
Collapse
Affiliation(s)
- E Tommasino
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy.
| | - F Bruno
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy
| | - A Catalucci
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy
| | - M Varrassi
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy
| | - P Sucapane
- Neurology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - D Cerone
- Neurology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - F Pistoia
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy
| | - E Di Cesare
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy
| | - A Barile
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy
| | - A Ricci
- Department of Neurosurgery, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy
| | - C Marini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - C Masciocchi
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy.
| | - A Splendiani
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, Via Vetoio 1 AQ, 67100, Italy.
| |
Collapse
|
12
|
YAMAMOTO K, ITO H, FUKUTAKE S, ODO T, KAMEI T, YAMAGUCHI T, TAIRA T. Focused Ultrasound Thalamotomy for Tremor-dominant Parkinson's Disease: A Prospective 1-year Follow-up Study. Neurol Med Chir (Tokyo) 2021; 61:414-421. [PMID: 33967176 PMCID: PMC8280323 DOI: 10.2176/nmc.oa.2020-0370] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Transcranial magnetic resonance (MR)-guided focused ultrasound (FUS) therapy is an emerging and minimally invasive treatment for movement disorders. There are limited reports on its long-term outcomes for tremor-dominant Parkinson's disease (TDPD). We aimed to investigate the 1-year outcomes of ventralis intermedius (VIM) thalamotomy with FUS in patients with TDPD. Patients with medication-refractory TDPD were enrolled and underwent unilateral VIM-FUS thalamotomy. Neurologists specializing in movement disorders evaluated the tremor symptoms and disability using Parts A, B, and C of the Clinical Rating Scale for Tremor (CRST) at baseline and at 1, 3, and 12 months. In all, 11 patients (mean age: 71.6 years) were included in the analysis. Of these, five were men. The median (interquartile range) improvement from baseline in hand tremor score, the total score, and functional disability score were 87.9% (70.5-100.0), 65.3% (55.7-87.7), and 66.7% (15.5-85.1), respectively, at 12 months postoperatively. This prospective study demonstrated an improvement in the tremor and disability of patients at 12 months after unilateral VIM-FUS thalamotomy for TDPD. In addition, there were no serious persistent adverse events. Our results indicate that VIM-FUS thalamotomy can be safely and effectively used to treat patients with TDPD. A randomized controlled trial with a larger cohort and long blinded period would help investigate the recurrence, adverse effects, placebo effects, and longer efficacy of this technique.
Collapse
Affiliation(s)
- Kazuaki YAMAMOTO
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Hisashi ITO
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Kanagawa, Japan
| | - Shigeru FUKUTAKE
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Kanagawa, Japan
| | - Takashi ODO
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Kanagawa, Japan
| | - Tetsumasa KAMEI
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Kanagawa, Japan
| | - Toshio YAMAGUCHI
- Research Institute of Diagnostic Imaging, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Takaomi TAIRA
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| |
Collapse
|
13
|
Wu P, Lin W, Li KH, Lai HC, Lee MT, Tsai KWK, Chiu PY, Chang WC, Wei CY, Taira T. Focused Ultrasound Thalamotomy for the Treatment of Essential Tremor: A 2-Year Outcome Study of Chinese People. Front Aging Neurosci 2021; 13:697029. [PMID: 34335232 PMCID: PMC8317688 DOI: 10.3389/fnagi.2021.697029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Essential tremor (ET) is a common movement disorder among elderly individuals worldwide and is occasionally associated with a high risk for mild cognitive impairment and dementia. This retrospective study aimed to determine the clinical outcome of unilateral magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy in Chinese patients with ET. Methods: In total, 31 male and 17 female patients with drug-refractory ET were enrolled in this research study from January 2017 to September 2019. The severity of tremor and disability were assessed using the Clinical Rating Scale for Tremor (CRST) within a 2-year follow-up period. Results: The mean age of the participants was 59.14 ± 13.5 years. The mean skull density ratio (SDR) was 0.5 ± 0.1. The mean highest temperature was 57.0 ± 2.4°C. The mean number of sonications was 10.0 ± 2.6. The average maximum energy was 19,710.5 ± 8,624.9 J. The total CRST scores and sub-scores after MRgFUS thalamotomy significantly reduced during each follow-up (p < 0.001). All but four (8.3%) of the patients had reversible adverse events (AEs) after the procedure. Conclusions: MRgFUS had sustained clinical efficacy 2 years after treatment for intractable ET. Only few patients presented with thalamotomy-related AEs including numbness, weakness, and ataxia for an extended period. Most Chinese patients were treated safely and effectively despite their low SDR.
Collapse
Affiliation(s)
- Peihan Wu
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Wei Lin
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Kun Hong Li
- MR-Guided Focused Ultrasound Center, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Hui-Chin Lai
- MR-Guided Focused Ultrasound Center, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Ming-Tsung Lee
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Nursing, Hungkuang University, Taichung, Taiwan
| | | | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Wei-Chieh Chang
- Department of Neurosurgery, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan.,Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|