Neurosurgical focus最新文献

{"title":"Patient-reported outcome and preference after craniotomy and laser interstitial thermal therapy ablation: a pilot study.","authors":"Isabela Peña Pino, Jiri Bartek, Sharona Ben-Haim, Clark C Chen","doi":"10.3171/2024.8.FOCUS24442","DOIUrl":"10.3171/2024.8.FOCUS24442","url":null,"abstract":"<p><strong>Objective: </strong>Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that allows cytoreduction of brain tumors and can be considered as an alternative to craniotomy. The authors surveyed 27 patients who underwent both craniotomy and LITT during distinct stages of their oncology journey to assess patient-reported outcomes comparing both procedures.</p><p><strong>Methods: </strong>A 9-question survey was developed and validated to assess patient-reported postoperative recovery, pain level, narcotic use, and procedure preference. The survey was administered to patients with WHO grade II-IV gliomas who underwent both craniotomy and LITT.</p><p><strong>Results: </strong>The survey was reviewed by independent surgeons, patient advocates, and patients for face validity and showed > 90% intrarater agreement over time. The cohort had a mean age of 57 ± 12 years, and 78% had glioblastoma. There was no significant difference in symptomatic improvement postcraniotomy or post-LITT (30% vs 4%, p = 0.17). Similarly, no significance was detected in patient-reported recovery time from craniotomy (time required to return to preoperative state: mean 4.3 ± 9.1 weeks, median 2 weeks) or LITT (mean 2 ± 2.3 weeks, median 1 week; p = 0.21). Notably, postsurgical pain (0-10 on the visual analog scale) and need for narcotic use in the first week (yes/no) after the procedure were significantly lower post-LITT (average visual analog scale score 1.7 vs 5 points, narcotic use 4% vs 81%; p < 0.0001 for both comparisons). When asked which procedure they would choose-having experienced both craniotomy and LITT-surveyed patients overwhelmingly chose LITT over craniotomy (89% vs 11%, p < 0.0001). Of note, the patients who preferred craniotomy experienced improved neurological function postcraniotomy or suffered new deficits post-LITT.</p><p><strong>Conclusions: </strong>In this pilot study, patients reported less pain and narcotic use post-LITT relative to craniotomy and generally preferred the former procedure if given the choice. Validation of these results in future studies can help inform decision-making in clinical scenarios where there is equipoise between LITT and craniotomy.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction. Complications: our best way to learn.","authors":"Roberto C Heros","doi":"10.3171/2024.7.FOCUS23740","DOIUrl":"10.3171/2024.7.FOCUS23740","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction. Focused ultrasound: current and future indications.","authors":"Rees Cosgrove, Vibhor Krishna, Kara Beasley, Nir Lipsman","doi":"10.3171/2024.6.FOCUS23739","DOIUrl":"10.3171/2024.6.FOCUS23739","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance-guided focused ultrasound in the treatment of refractory essential tremor: a systematic review and meta-analysis.","authors":"Ali Mortezaei, Muhammed Amir Essibayi, Mohammad Mirahmadi Eraghi, Mohammadreza Alizadeh, Khaled M Taghlabi, Emad N Eskandar, Amir H Faraji","doi":"10.3171/2024.6.FOCUS24326","DOIUrl":"10.3171/2024.6.FOCUS24326","url":null,"abstract":"<p><strong>Objective: </strong>Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging treatment for medication-refractory essential tremor (ET). The objective of this study was to evaluate long-term (up to 5 years) safety and efficacy of unilateral MRgFUS in the treatment of ET.</p><p><strong>Methods: </strong>The authors performed a systematic search through 4 databases to find relevant clinical studies. Binary outcomes were analyzed and reported as odds ratios and 95% confidence intervals, while continuous outcomes were analyzed and reported as standardized mean differences (SMDs) and 95% confidence intervals. Furthermore, a univariable meta-regression was performed to evaluate the association between various covariates and the outcomes including the mean difference in the Clinical Rating Scale for Tremor (CRST) score and hand tremor scores. Sensitivity analysis was performed to address any heterogeneity.</p><p><strong>Results: </strong>A total of 43 studies comprising 1818 patients with ET who underwent MRgFUS were identified. Of the 1539 patients with data on sex, 1095 (71.2%) were male. The mean follow-up duration ranged from 3 months to 8.4 years among the studies. The mean total CRST score significantly decreased at 3, 6, and 12 months post-MRgFUS (SMD -4.5, p = 0.0069; SMD -4.9, p = 0.0045; and SMD -2.95, p = 0.0039, respectively). The mean hand tremor scores significantly mitigated at 3, 6, 12, 24, and 36 months post-MRgFUS (SMD -3.99, p = 0.05; SMD -4.5, p = 0.05; SMD -1.99, p < 0.0001; SMD - 2.07, p = 0.0002; and SMD -2.1, p < 0.0001, respectively). Furthermore, the mean Quality of Life in Essential Tremor Questionnaire scores were improved at 3 months (SMD -2.8, p = 0.0025), 6 months (SMD -4.1, p = 0.04), 12 months (SMD -1.57, p = 0.0004), 2 years (SMD -1.64, p = 0.0003), and 3 years (SMD -1.14, p = 0.08). Our meta-regression findings showed that sex (p = 0.03), unlike age, handedness, symptom duration, and peak energy levels at 3 months, was associated with a significantly higher mean difference in tremor severity.</p><p><strong>Conclusions: </strong>This meta-analysis provides strong evidence supporting the efficacy and safety of unilateral MRgFUS for the treatment of ET in terms of tremor severity and quality of life with acceptable adverse events.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of sonodynamic therapy for brain tumors.","authors":"Dana L Hutton, Terry C Burns, Kismet Hossain-Ibrahim","doi":"10.3171/2024.6.FOCUS24338","DOIUrl":"10.3171/2024.6.FOCUS24338","url":null,"abstract":"<p><strong>Objective: </strong>Sonodynamic therapy (SDT) is gaining attention as a promising new noninvasive brain tumor treatment that targets and selectively kills tumor cells, with limited side effects. This review examines the mechanisms of SDT and ongoing clinical trials looking at optimization of sonication parameters for potential treatment of glioblastoma (GBM) and diffuse intrinsic pontine glioma (DIPG). The results in the first patient with recurrent GBM treated at the Mayo Clinic are briefly discussed.</p><p><strong>Methods: </strong>The authors of this literature review used electronic databases including PubMed, EMBASE, and OVID. Articles reporting relevant preclinical and clinical trials were identified by searching for text words/phrases and MeSH terms, including the following: \"sonodynamic therapy,\" \"SDT,\" \"focused ultrasound,\" \"5-ALA,\" \"ALA,\" \"brain tumors,\" \"diffuse pontine glioma,\" \"glioblastoma,\" and \"high grade glioma.\"</p><p><strong>Results: </strong>Preclinical and clinical trials investigating the specific use of SDT in brain tumors were reviewed. In preclinical models of high-grade glioma and GBM, SDT has shown evidence of targeted tumor cell death via the production of reactive oxygen species. Emerging clinical trial results within recurrent GBM and DIPG show evidence of successful treatment response, with minimal side effects experienced by recruited patients. So far, SDT has been shown to be a promising noninvasive cancer treatment that is well tolerated by patients. The authors present pilot data suggesting good radiological response of GBM to a single SDT treatment, with unpublished observation of a lack of off-target effects even after multiple (monthly) sonication outpatient treatments. The scope of the clinical trials of SDT is to investigate whether it can be the means by which the fatal diagnosis of GBM or DIPG is converted into that of a chronic, treatable disease.</p><p><strong>Conclusions: </strong>SDT is safe, repeatable, and better tolerated than both chemotherapy and radiotherapy. It has been shown to have an effect in human cancer therapy, but more clinical trials are needed to establish standardized protocols for sonosensitizer delivery, treatment parameters, and combination therapies. The most appropriate timing of treatment also remains to be determined-whether to prevent recurrence in the postoperative period, or as a salvage option in patients with recurrent GBM for which redo surgery is inappropriate. It is hoped that SDT will also be developed for a wider spectrum of clinical indications, such as metastases, meningioma, and low-grade glioma. Further clinical trials are in preparation.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain targeting for focused ultrasound essential tremor ablation: proceedings from the 2023 Focused Ultrasound Foundation workshop.","authors":"Melissa M J Chua, Suzanne LeBlang, Lauren Powlovich, Tom Gilbertson, Vibhor Krishna, Charles R G Guttmann, Matthew D C Eames, Frantz R Poulsen, G Rees Cosgrove","doi":"10.3171/2024.6.FOCUS2494","DOIUrl":"10.3171/2024.6.FOCUS2494","url":null,"abstract":"<p><p>Essential tremor (ET) is the most common movement disorder globally and has negative impacts on quality of life. While medical treatments exist, approximately 50% of patients have tremor that is refractory to medication or experience intolerable medication side effects. Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an option for these patients and while incisionless, it is still invasive, although less so than other surgical treatments such as deep brain stimulation and radiofrequency thalamotomy. Despite MRgFUS being FDA-approved since 2016, there is still no current consensus on the best approaches for targeting, imaging, and outcome measurement. A 2-day workshop held by the Focused Ultrasound Foundation in September of 2023 convened experts and critical stakeholders in the field to share their knowledge and experiences. The goals of the workshop were to determine the optimal target location within the thalamus and compare best practices for localizing the target and tracking patient outcomes. This paper summarizes the current landscape, important questions, and discussions that will help direct future treatments to improve patient care and outcomes.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MR-guided focused ultrasound in pediatric neurosurgery: current insights, technical challenges, and lessons learned from 45 treatments at Children's National Hospital.","authors":"Gregory F Keating, Kelsi M Chesney, Nirali Patel, Lindsay Kilburn, Adriana Fonseca, Roger J Packer, Chaitanya Challa, Patrick F O'Brien, Daniel A Donoho, John S Myseros, Chima Oluigbo, Robert F Keating, Hasan R Syed","doi":"10.3171/2024.6.FOCUS24332","DOIUrl":"10.3171/2024.6.FOCUS24332","url":null,"abstract":"<p><strong>Objective: </strong>MR-guided focused ultrasound (MRgFUS) is an evolving technology with numerous present and potential applications in pediatric neurosurgery. The aim of this study was to describe the use of MRgFUS, technical challenges, complications, and lessons learned at a single children's hospital.</p><p><strong>Methods: </strong>A retrospective analysis was performed of a prospectively collected database of all pediatric patients undergoing investigational use of MRgFUS for treatment of various neurosurgical pathologies at Children's National Hospital. Treatment details, clinical workflow, and standard operating procedures are described. Patient demographics, procedure duration, and complications were obtained through a chart review of anesthesia and operative reports.</p><p><strong>Results: </strong>In total, 45 MRgFUS procedures were performed on 14 patients for treatment of diffuse intrinsic pontine glioma (n = 12), low-grade glioma (n = 1), or secondary dystonia (n = 1) between January 2022 and April 2024. The mean age at treatment was 9 (range 5-22) years, and 64% of the patients were male. With increased experience, the total anesthesia time, sonication time, and change in core body temperature during treatment all significantly decreased. Complications affected 4.4% of patients, including 1 case of scalp edema and 1 patient with a postprocedure epidural hematoma. Device malfunction requiring abortion of the procedure occurred in 1 case (2.2%). Technical challenges related to transducer malfunction and sonication errors occurred in 6.7% and 11.1% of cases, respectively, all overcome by subsequent user modifications.</p><p><strong>Conclusions: </strong>The authors describe the largest series on MRgFUS technical aspects in pediatric neurosurgery at a single institution, comprising 45 total treatments. This study emphasizes potential technical challenges and provides valuable insights into the nuances of its application in pediatric patients.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3-T MR-guided focused ultrasound thalamotomy for tremor in patients with a cardiac pacemaker: case series and review of the literature.","authors":"Lain H Gonzalez-Quarante, Antonio Gonzalez-Crespo, Alana Arcadi, Marta Macias-de-la-Corte, Iciar Aviles-Olmos, Carlos A Sanchez-Catasus, Elena Cacho-Asenjo, Cristina Honorato-Cia, Antonio Martinez-Simon, Arantza Gorospe, Antonio Martin-Bastida, Paula Corral-Alonso, Maria C Rodriguez-Oroz, Jorge Guridi","doi":"10.3171/2024.6.FOCUS24171","DOIUrl":"10.3171/2024.6.FOCUS24171","url":null,"abstract":"<p><p>MR-guided focused ultrasound (MRgFUS) has proven its efficacy and safety for the treatment of essential tremor (ET) and/or Parkinson's disease (PD). However, having a cardiac pacemaker has been considered an exclusion criterion for the use of MRgFUS. Only 2 patients with a cardiac pacemaker treated with MRgFUS have been previously reported, both treated using 1.5-T MRI. In this paper, the authors present their experience performing 3-T MRgFUS thalamotomy in 4 patients with an implanted cardiac pacemaker. Treatments were uneventful regarding complications or severe side effects. MRgFUS using 3-T MRI was found to be an efficient and safe treatment for ET and/or PD in patients with an MRI-compatible pacemaker.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of focused ultrasound for psychiatric disorders: current applications, opportunities, and challenges.","authors":"Matthew C Henn, Haley D Smith, Christian G Lopez Ramos, Beck Shafie, Jefferson Abaricia, Ian Stevens, Alexander P Rockhill, Daniel R Cleary, Ahmed M Raslan","doi":"10.3171/2024.6.FOCUS24278","DOIUrl":"10.3171/2024.6.FOCUS24278","url":null,"abstract":"<p><strong>Objective: </strong>Advancements in MRI-guided focused ultrasound (MRgFUS) technology have led to the successful treatment of select movement disorders. Based on the comparative success between ablation and deep brain stimulation, interest arises in focused ultrasound (FUS) as a promising treatment modality for psychiatric illnesses. In this systematic review, the authors examined current applications of FUS for psychiatric conditions and explored its potential opportunities and challenges.</p><p><strong>Methods: </strong>The authors performed a comprehensive review using the PRISMA guidelines of studies investigating psychiatric applications for FUS. Articles indexed on PubMed between 2014 to 2024 were included. The authors synthesized the psychiatric conditions treated, neural targets, outcomes, study design, and sonication parameters, and they reviewed important considerations for the treatment of psychiatric disorders with FUS. They also discussed active clinical trials in this research domain.</p><p><strong>Results: </strong>Of 250 articles, 10 met the inclusion criteria. Eight articles investigated the clinical, safety, and imaging correlates of MRgFUS in obsessive-compulsive disorder (OCD), whereas 3 examined treatment-resistant depression. Bilateral anterior capsulotomy resulted in a full responder rate of 67% (≥ 35% reduction in the Yale-Brown Obsessive-Compulsive Scale score) and 33% (≥ 50% reduction in the score on the Hamilton Rating Scale for Depression) in OCD and treatment-resistant depression, respectively. Sonications ranged from 8 to 36 with targeted lesional temperatures of 51°C-56°C. Lesions in the anterodorsal aspect of the anterior limb of the internal capsule (ALIC) and increased functional connectivity to the left dorsolateral prefrontal cortex and dorsal anterior cingulate cortex significantly predicted reduction in symptoms among patients with OCD, with decreases in beta-band activity in the frontocentral and temporal regions associated with reductions in depression and anxiety. Treatment of the nucleus accumbens with low-intensity FUS (LIFU) in patients with opioid-use disorders resulted in significant reductions in cue-reactive cravings, lasting up to 90 days. No serious adverse events were reported, including cognitive decline. Side effects were generally mild and transient, consisting of headaches, pin-site swelling, and nausea. Fourteen active clinical trials were identified, primarily targeting depression with LIFU.</p><p><strong>Conclusions: </strong>Currently, FUS for psychiatric conditions is centered on OCD, with early pilot studies demonstrating promising safety and efficacy. Further research expanding on defining optimal patient selection, study design, intensity, and sonication parameters is warranted, particularly as FUS expands to other psychiatric illnesses and incorporates LIFU paradigms. Ethical considerations such as patient consent and equitable access also remain paramount.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Endovascular treatment for ACF DAVF: most recent real-world experience.","authors":"Ahmet Günkan, Marcio Yuri Ferreira, Savio Batista, Raphael Bertani, Christian Ferreira, Yafell Serulle","doi":"10.3171/2024.5.FOCUS24305","DOIUrl":"10.3171/2024.5.FOCUS24305","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}