Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor in Fahr's Disease: Case Report.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-21 DOI:10.1159/000541446

Jean Filo, Martina L Mustroph, Melissa M J Chua, Philip J White, Nathan J McDannold, G Rees Cosgrove

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Abstract

Introduction: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy effectively treats medication-resistant essential tremor (ET). Usually, intracranial calcifications are excluded as no-pass zones because of their low penetrability which may limit the effectiveness of treatment and lead to unintended side effects. This case report illustrates the efficacy of unilateral MRgFUS for tremor control in a patient with extensive basal ganglia calcifications due to Fahr's disease.

Case presentation: A 69-year-old right-handed male with debilitating Fahn-Tolosa-Marin grade 3-4 bilateral hand tremor underwent unilateral left MRgFUS thalamotomy. The treatment involved careful preoperative planning to accommodate his extensive basal ganglia calcifications, element path consideration, and skull density ratio to ensure accurate and effective lesioning. Posttreatment, the patient exhibited complete abolition of tremor on the treated side with minor transient dysarthria and imbalance. Follow-up at 12 weeks posttreatment showed sustained tremor relief and an absence of any adverse effects, validating the procedural adjustments made to accommodate the unique challenges posed by his intracranial calcifications.

Conclusion: MRgFUS can be safely and effectively applied in certain patients with extensive basal ganglia calcifications - in this case, due to Fahr's disease. This case report suggests expanding the application of MRgFUS to patients with extensive intracranial calcifications who previously might not have been considered suitable candidates for MRgFUS.

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磁共振引导下聚焦超声丘脑切开术治疗法尔氏病重度震颤：病例报告。

简介：磁共振引导下聚焦超声（MRgFUS）丘脑切开术能有效治疗药物抵抗性本质性震颤（ET）。通常，颅内钙化因其穿透性低而被排除在禁区之外，这可能会限制治疗效果并导致意外的副作用。本病例报告说明了单侧 MRgFUS 对一名因法尔氏病导致基底节广泛钙化的患者控制震颤的疗效：一名 69 岁的右撇子男性患者因患有法恩-托洛萨-马林 3-4 级双侧手震颤而衰弱不堪，接受了单侧左侧 MRgFUS 丘脑切开术。治疗过程包括仔细的术前规划，以适应其广泛的基底节钙化、元素路径考虑和头骨密度比，从而确保准确有效的病变切除。治疗后，患者接受治疗的一侧震颤完全消失，仅有轻微的一过性构音障碍和失衡。治疗后12周的随访显示震颤持续缓解且无任何不良反应，验证了为应对颅内钙化带来的独特挑战而进行的程序调整：结论： MRgFUS 可以安全有效地应用于某些基底节广泛钙化的患者--在本病例中，钙化是由法尔氏病引起的。本病例报告建议将 MRgFUS 的应用范围扩大到颅内广泛钙化的患者，这些患者以前可能不适合接受 MRgFUS 治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.