Magnetic Resonance-Guided High Intensity Focused Ultrasound for Treating Movement Disorders.

Q2 Medicine
Progress in neurological surgery Pub Date : 2018-01-01 Epub Date: 2018-01-12 DOI:10.1159/000481080
Young Goo Kim, Eun Jung Kweon, Won Seok Chang, Hyun Ho Jung, Jin Woo Chang
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引用次数: 4

Abstract

Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) surgery has recently gained favor as a novel, noninvasive alternative to conventional neurosurgery. In contrast to traditional ablative interventions, transcranial MRgFUS surgery is entirely imaging-guided and uses continuous temperature measurements at the target and surrounding tissue taken in real-time. Unlike Gamma Knife radiosurgery, MRgFUS surgery can make a lesion immediately and does not use ionizing radiation. Moreover, since no metallic device is implanted, MR imaging-based diagnosis is not restricted throughout life. An additional strength of transcranial MRgFUS surgery is its ability to focus acoustic energy through the intact skull onto deep-seated targets, while minimizing adjacent tissue damage. Even though the established indications of MRgFUS include bone metastases, uterine fibroids, and breast lesions, several promising preclinical and phase I clinical trials of neuropathic pain, essential tremor, Parkinson's disease (PD), and obsessive-compulsive disorder have demonstrated that the delivery of focused ultrasound energy promises to be a broadly applicable technique. For instance, this technique can be used to generate focal intracranial thermal ablative lesions of brain tumors, or to silence dysfunctional neural circuits and disrupt the blood-brain barrier for targeted drug delivery and the modulation of neural activity. Here we review the general principles of MRgFUS and its current applications, with a special focus on movement disorders such as essential tremor and PD, and discuss controversies and limitations of this technique.

磁共振引导的高强度聚焦超声治疗运动障碍。
经颅磁共振引导的聚焦超声(MRgFUS)手术最近作为一种新颖的、无创的传统神经外科手术的替代方法而受到青睐。与传统的烧蚀治疗相比,经颅磁共振gfus手术完全是在成像引导下进行的,并对目标和周围组织进行连续的实时温度测量。与伽玛刀放射外科手术不同,MRgFUS手术可以立即造成病变,并且不使用电离辐射。此外,由于没有金属装置植入,基于磁共振成像的诊断在整个生命中都不受限制。经颅MRgFUS手术的另一个优点是它能够通过完整的颅骨将声能集中到深部目标上,同时最大限度地减少邻近组织的损伤。尽管MRgFUS已确定的适应症包括骨转移、子宫肌瘤和乳腺病变,但在神经性疼痛、特发性震颤、帕金森病(PD)和强迫症等方面的临床前和I期临床试验表明,聚焦超声能量的输送有望成为一种广泛适用的技术。例如,该技术可用于产生局灶性颅内热烧蚀脑肿瘤病变,或沉默功能失调的神经回路,破坏靶向药物输送和神经活动调节的血脑屏障。在此,我们回顾了MRgFUS的一般原理及其目前的应用,特别关注运动障碍,如特发性震颤和PD,并讨论了该技术的争议和局限性。
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期刊介绍: Published since 1966, this series has become universally recognized as the most significant group of books serving neurological surgeons. Volumes feature contributions from distinguished international surgeons, who brilliantly review the literature from the perspective of their own personal experience. The result is a series of works providing critical distillations of developments of central importance to the theory and practice of neurological surgery.
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