Stereotactic and Functional Neurosurgery最新文献

{"title":"Epidemiology of Resistant Cancer Pain: Prevalence, Clinical Burden, and Treatment Gaps.","authors":"Aaron Lawson McLean, Julian Kahr, Jean Régis, Marcel A Kamp, Christian Senft","doi":"10.1159/000547446","DOIUrl":"10.1159/000547446","url":null,"abstract":"<p><strong>Background: </strong>Resistant cancer pain (RCP) remains a challenge in oncology, affecting patients whose pain persists despite guideline-based treatment. While advancements in pharmacological and interventional strategies have improved cancer pain management, barriers such as opioid access restrictions, provider knowledge gaps, and underutilization of specialized pain interventions contribute to inadequate relief. Understanding the epidemiology, classification, and risk factors for RCP is essential for improving treatment.</p><p><strong>Summary: </strong>This review examines the prevalence, pathophysiology, and burden of RCP, highlighting its impact on quality of life and healthcare systems. Pain severity is commonly assessed using numerical rating scales, but comprehensive frameworks like the Edmonton Classification System for Cancer Pain (ECS-CP) provide better insight into complex pain syndromes. Breakthrough pain, neuropathic pain, and cancer-induced bone pain are frequently linked to treatment resistance. While opioids remain central to pharmacological management, many patients require multimodal approaches, including adjuvant analgesics, interventional procedures, and radiation therapy. Neurosurgical options such as cordotomy, intrathecal drug delivery, and myelotomy offer pain relief in select cases but are underutilized due to limited awareness and training.</p><p><strong>Key messages: </strong>RCP remains a major unmet medical need, affecting many cancer patients despite advances in pain management. Effective treatment requires a multimodal, individualized approach integrating pharmacological, interventional, and neurosurgical strategies. While neurosurgical interventions provide substantial relief in selected patients, their use is often limited by referral delays and lack of provider awareness. Overcoming systemic barriers, refining pain classification, and expanding access to specialized pain management are essential to improving RCP care.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurosurgical Techniques for Chronic Pain in Adult Cancer Survivors.","authors":"Juan Manuel Altamirano, Syed I Khalid, Konstantin V Slavin","doi":"10.1159/000547391","DOIUrl":"10.1159/000547391","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is a prevalent and often undertreated issue for adult cancer survivors, lasting well beyond the completion of curative treatment or during prolonged maintenance therapy. Historically, pain management in this population has followed strategies similar to those used for active cancer pain - primarily systemic opioids - despite the long-term risks of functional decline, endocrine disruption, and misuse during periods of survivorship that may span decades.</p><p><strong>Summary: </strong>This review examines the evolving role of neuromodulatory and functional neurosurgical interventions for chronic pain in adult cancer survivors. It focuses on five core modalities: spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRGS), peripheral nerve stimulation (PNS), intrathecal drug delivery systems (IDDSs), and cortical stimulation. These interventions are placed in context with three survivor groups: those cured of disease, those living with stable disease on chronic therapy, and survivors of hematopoietic cell transplantation. Emerging clinical evidence supports the use of SCS for treatment-related neuropathic and mixed pain syndromes, while DRGS and PNS show promise in addressing focal neuropathic conditions. IDDS offers a means to deliver targeted analgesia in patients suffering from diffuse or opioid-refractory pain, and cortical stimulation is currently being investigated for highly refractory cases. Each modality is examined in relation to common pain syndromes in survivorship, including chemotherapy-induced peripheral neuropathy, post-surgical neuropathy, radiation fibrosis, graft-versus-host disease-related pain, and musculoskeletal or myofascial pain. The review also explores unique survivorship considerations such as immunosuppression, device longevity, healing complications, and disparities in access and coverage.</p><p><strong>Key messages: </strong>Neuromodulation and functional neurosurgical techniques represent an emerging approach for managing chronic pain in adult cancer survivors, providing alternatives to systemic pharmacotherapy that may enhance quality of life and functional independence. The clinical application of these interventions should be guided by pain phenotype, underlying pathophysiology, and long-term survivorship needs. Their integration into cancer survivorship care necessitates careful consideration of patient selection, device management over time, procedural risks in immunocompromised individuals, and the ethical imperative for informed, shared decision-making.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":2.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There a Role for Focused Ultrasound in the Treatment of Refractory Epilepsy?","authors":"Alexander Agopyan-Miu, Grace B Simmons, Gordon H Baltuch","doi":"10.1159/000547265","DOIUrl":"10.1159/000547265","url":null,"abstract":"<p><strong>Background: </strong>Although patients with drug-resistant epilepsy (DRE) have a <5% chance of seizure freedom with continued polypharmacy, surgical interventions remain underutilized. One potential driver of this trend is patient perceived fear of open surgery. Focused ultrasound is an incisionless, minimally invasive technique that has been used to treat epilepsy and has the potential to have a larger footprint within the epilepsy surgeon's armamentarium.</p><p><strong>Summary: </strong>A brief overview of the underutilization of epilepsy surgery, the epilepsy treatment landscape, and current and emerging applications of focused ultrasound for DRE will be discussed. This article includes a brief comparison of focused ultrasound with other alternatives to open epilepsy surgery and a summary and appraisal of the existing literature.</p><p><strong>Key messages: </strong>Focused ultrasound serves as a versatile, minimally invasive option for patients with contraindications to or concerns with open surgery or radiation exposure. Preliminary studies indicate disease-modifying benefit of high-intensity focused ultrasound (HIFU) ablation and potential neuromodulatory benefit and increased blood-brain barrier permeability of low-intensity focused ultrasound (LIFU). Higher level evidence is needed to elucidate the efficacy of LIFU and HIFU for the treatment of epilepsy. However, focused ultrasound is an emerging treatment modality that has the potential to transcend the traditional ablation paradigm and alter the cellular composition of epileptic networks for therapeutic effect.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-17"},"PeriodicalIF":2.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty Indices in Patients Undergoing Functional Neurosurgical Procedures: A Systematic Review.","authors":"Carmelo Venero, Joanna M Roy, Nirbha Ghurye, Akshay Warrier, Muhammad Usman Khalid, Niels Pacheco-Barrios, Farhan A Mirza, Christian A Bowers","doi":"10.1159/000547128","DOIUrl":"10.1159/000547128","url":null,"abstract":"<p><strong>Introduction: </strong>Functional neurosurgery covers a wide array of neurological disorders with an equally vast array of treatment modalities, including neuromodulation, decompressive, and ablative therapies for disparate pathologies such as pain, neuromodulation, disconnection, and refractory epilepsy. One of the most common functional treatments is deep brain stimulation for movement disorders and select psychiatric diseases. Functional neurosurgery treats patients with reduced quality of life from pathological neuronal pathways. Optimal patient selection by preoperatively identifying high-risk patients is critical for avoiding as many operative complications as possible, in addition to managing complications better once they occur. Frailty indices have demonstrated superior discrimination in predicting adverse postoperative outcomes across the spectrum of neurosurgical subspecialties when compared to increasing patient age. This systematic review describes multiple different frailty indices utilized by patients undergoing functional neurosurgery procedures.</p><p><strong>Methods: </strong>A systematic review of literature was performed using PubMed. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias and studies with NOS >6 were considered high-quality. An initial search identified 541 articles through our search strategy and, after screening and review, five met criteria for inclusion The 5-factor modified frailty index (mFI-5) and Risk Analysis Index (RAI) were most frequently utilized (n = 5). One study utilized single-hospital databases in contrast to the nationwide databases utilized by the other four studies.</p><p><strong>Results: </strong>RAI was found to have superior predictive ability as frailty metric when compared to the mFI-5. All five studies were considered high-quality based on the NOS. Frailty indices have demonstrated the ability to predict adverse outcomes in patients undergoing procedures from across the spectrum of neurosurgical subspecialties.</p><p><strong>Conclusion: </strong>Our review identified articles that utilized frailty indices in predicting outcomes among patients undergoing functional neurosurgery procedures.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing LEATs in Patients with Refractory and Non-Refractory Epilepsy.","authors":"Arjun Rohit Adapa, Hannah Haile, Guy M McKhann","doi":"10.1159/000546652","DOIUrl":"https://doi.org/10.1159/000546652","url":null,"abstract":"<p><p>Background Long-term/low grade epilepsy-associated tumors (LEATs) compose a complex group of low-grade brain neoplasms associated with drug-resistant focal epilepsy, primarily affecting pediatric and adolescent populations. LEATs exhibit significant epileptogenic potential, profoundly impacting patients' neurological and psychosocial outcomes. Advances in molecular pathology, particularly the identification of BRAF V600E and FGFR1 mutations, have enhanced the classification and understanding of these tumors, opening potential avenues for targeted therapies. Summary This review synthesizes current knowledge on LEAT biology, epileptogenesis, and clinical manifestations, highlighting the tumor microenvironment's role in seizure generation through disrupted neurotransmitter signaling, inflammatory processes, and network hyperexcitability. The integration of advanced neuroimaging, electrophysiology, and molecular diagnostics has refined LEAT detection and classification, improving surgical decision-making. Surgical resection remains the mainstay of treatment, with seizure freedom rates exceeding 80% when combined with tailored epilepsy surgery. However, variability in surgical outcomes underscores the need for individualized approaches, incorporating emerging minimally invasive techniques, such as laser interstitial thermal therapy (LITT), and neuromodulation strategies. Key Messages Despite advancements in the diagnosis and treatment of LEATs, key challenges remain, including refractory epilepsy, malignant progression, and the long-term impact of LEATs on cognitive function. Future research aims to refine the molecular and histopathological classification of LEATs, develop predictive biomarkers for seizure outcomes, and explore precision therapies targeting tumor-associated epileptogenesis. As the field evolves, a multidisciplinary approach integrating surgery, molecular therapeutics, and neurorehabilitation will be essential in optimizing patient outcomes.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-29"},"PeriodicalIF":1.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Feasibility and Complication Analyses of Extraoperative (Bedside) Removal of Stereo-Electroencephalography Electrodes.","authors":"Jiahao J Chen, Thandar Aung, Theodora Constantine, Jorge Alvaro Gonzalez-Martinez","doi":"10.1159/000545984","DOIUrl":"10.1159/000545984","url":null,"abstract":"<p><strong>Introduction: </strong>Stereotactic electroencephalography (SEEG) involves the implantation of intracortical electrodes for the precise localization of the epileptogenic zone and is well-established in terms of its safety and efficacy during implantation; however, there is a notable lack of research comparing different electrode removal techniques, specifically regarding complications and feasibility of these approaches. This study evaluates the feasibility and clinical utility of intraoperative versus extraoperative (bedside) removal of stereotactic electroencephalography (SEEG) electrodes.</p><p><strong>Methods: </strong>The early feasibility study retrospectively reviewed 117 consecutive SEEG patients at our institution, comparing 101 intraoperative cases with 16 extraoperative cases. A total of 1,624 SEEG electrodes were evaluated. Results related to demographics, feasibility of bedside removal, and occurrence of complications were analyzed and statistically compared between groups.</p><p><strong>Results: </strong>Our findings reveal comparable patient demographics across both groups and demonstrate low complication rates of 1.98% for intraoperative and 0.00% for extraoperative removals, with a combined rate of 1.71%. Importantly, zero cases of infection were observed in both settings. In addition to the low rates of complication in both the intraoperative and extraoperative explant groups, the study indicates a statistically significantly reduced use of sedation in the extraoperative group, which may enhance patient comfort and eliminate the need for additional sedatives during their ongoing treatment. The extraoperative bedside approach also offers practical benefits, such as removing the need for operating room (OR) resources and staffing, which can prevent OR delays and contribute to shorter hospital stays.</p><p><strong>Conclusion: </strong>With the appropriate indications, the extraoperative removal of SEEG electrodes appears to be a feasible and safe alternative to the intraoperative method. It presents potential advantages in optimizing patient flow within epilepsy monitoring units, improving operational efficiency, and potentially reducing healthcare costs while promoting patient comfort. Future research is essential to validate these findings further and refine the bedside technique for broader clinical application.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Robots in Epilepsy Surgery.","authors":"Matthias Tomschik, Sarina Noelle Somer, Christian Dorfer","doi":"10.1159/000545985","DOIUrl":"10.1159/000545985","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy is a prevalent chronic neurological disease affecting millions. Many patients respond to medical therapies, but a third of patients does not and potentially requires neurosurgical procedures. These can be used to localize the onset of seizures and subsequently treat patients. Robotic technologies have emerged over the last decades to increase the efficacy and safety of epilepsy surgery. We therefore wanted to describe the role that robotics in epilepsy surgery have taken since their introduction more than 30 years ago.</p><p><strong>Summary: </strong>Robotic assistance in epilepsy surgery has evolved for more than 30 years. Its earliest use in stereotactic EEG (SEEG) implantations has now also become its most widely used application. Multiple studies have demonstrated that robotic guidance increases the accuracy while also making the implantation of electrodes faster. Beyond diagnostics, robotics have also gained widespread acceptance in ablative neurosurgical procedures where robotic systems improve the placement and can even aid in the fine-tuning of laser fibers for laser interstitial thermotherapy. Additionally, robotics has been employed in the placement of electrodes for intracranial neuromodulation therapies in epilepsy such as deep brain stimulation and responsive neurostimulation. Ongoing innovations are further expanding the uses of robotic technologies in epilepsy surgery from aiding in endoscopic procedures to automated craniotomies.</p><p><strong>Key messages: </strong>Robotics in epilepsy surgery has come a long way and has already taken a central role in procedure intended for diagnostic and therapeutic purposes. This narrative review details its many benefits and provides an outlook for future developments.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automatic Detection of Directional Lead Orientation in Deep Brain Stimulation using Photon-Counting Detector Computed Tomography: A Phantom Study.","authors":"Stefan Hunsche, Alexandra Hellerbach, Markus Eichner, Christoph Panknin, Sebastian Faby, Jochen Wirths, Veerle Visser-Vandewalle, Harald Treuer, Dieter Fedders","doi":"10.1159/000541151","DOIUrl":"10.1159/000541151","url":null,"abstract":"<p><strong>Introduction: </strong>Photon-counting detector computed tomography (PCD-CT) represents the next generation of CT technology, offering enhanced capabilities for detecting the orientation of directional leads in deep brain stimulation (DBS). This study aims to refine PCD-CT-based lead orientation determination using an automated method applicable to devices from various manufacturers, addressing current methodological limitations and improving neurosurgical precision.</p><p><strong>Methods: </strong>An automated method was developed to ascertain the orientation of directional DBS leads using PCD-CT data and grayscale model fitting for devices from Boston Scientific, Medtronic, and Abbott. A phantom study was conducted to evaluate the precision and accuracy of this method, comparing it with the stripe artifact method across different lead alignments relative to the CT gantry axis.</p><p><strong>Results: </strong>Except for the Medtronic Sensight™ lead, where detection was occasionally unfeasible if aligned normal to the z-axis of the CT gantry, a clinically very unlikely alignment, the lead orientation could be automatically determined regardless of its position. The accuracy and precision of this automated method was comparable to those of the stripe artifact method.</p><p><strong>Conclusion: </strong>PCD-CT enables the automatic determination of lead orientation from leading manufacturers with an accuracy comparable to the stripe artifact method, and it offers the added benefit of being independent of the clinically occurring orientation of the head and, consequently, the lead relative to the CT gantry axis.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"55-62"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gamma Knife Radiosurgery for Glossopharyngeal Neuralgia: A Retrospective Study.","authors":"Humanitas Research Hospital S P A, Andrea Franzini, Piero Picozzi, Zefferino Rossini, Maria Pia Tropeano, Beatrice Claudia Bono, Ali Baram, Pierina Navarria, Federico Pessina","doi":"10.1159/000545986","DOIUrl":"10.1159/000545986","url":null,"abstract":"<p><strong>Introduction: </strong>The treatment of patients with glossopharyngeal neuralgia (GN) refractory to medical therapies is challenging. Gamma knife radiosurgery (GKRS) has emerged as an incisionless treatment option with outcomes reported in a limited number of studies. The aim of this study was to report on the outcomes of GKRS in patients with GN treated at our center.</p><p><strong>Methods: </strong>We retrospectively reviewed all patients with GN who underwent GKRS at our center since 2017. Pain intensity was evaluated using the Barrow Neurological Institute (BNI) pain score modified for GN. Adverse events were recorded.</p><p><strong>Results: </strong>Six patients underwent GKRS for GN at our center between 2017 and 2024. The maximum dose delivered was 85 Gy for 1 patient and 90 Gy for the others. After a median period of 2 weeks from GKRS, all patients experienced pain reduction (BNI I-IIIa). Pain recurred during follow-up in 2 patients after 9 and 3 months, respectively. Both underwent repeat GKRS, which relieved pain in one. No adverse event or neurological deficit occurred.</p><p><strong>Conclusions: </strong>GKRS is an effective, well-tolerated treatment for patients with GN. Pain may recur over time, but more durable pain relief can be achieved with repeat GKRS.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"219-226"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focused Ultrasound in the Treatment of Epilepsy: Current Applications and Future Directions.","authors":"Benjamin Sterling Succop, Andreas Seas, Joshua Woo, Kevin Jesus Bode Padron, Alyssa M Bartlett, Bhavya Shah, Shruti Agashe, Stephen Harward Ii","doi":"10.1159/000545716","DOIUrl":"10.1159/000545716","url":null,"abstract":"<p><strong>Introduction: </strong>Epilepsy is the fourth most common neurological disorder, affecting nearly 1% of the global population. Despite recent advancements in medical therapies, approximately one-third of patients remain refractory to treatment, necessitating consideration of surgical intervention. Historically, epilepsy surgery has been invasive and maximalist in nature, involving extensive brain resections with significant risk for morbidity. However, emerging approaches offer promising, less-invasive alternatives. One such technique is focused ultrasound (FUS), a rapidly evolving, incisionless, image-guided therapy that allows physicians to precisely target specific brain regions with ultrasonic energy to achieve a range of therapeutic effects.</p><p><strong>Methods: </strong>Systematic methods were implemented to define the scope of preclinical and clinical applications of FUS to treat epilepsy. Inclusion criteria included preclinical experiment, case study, case series, cohort studies, and clinical trials involving therapeutic application of FUS for treatment of epilepsy of any etiology. The primary exclusion criterion was FUS for indications other than treatment of epilepsy.</p><p><strong>Results: </strong>Forty-six published articles and 9 ongoing clinical trials were included for a total of 55 studies. For ablative therapies, 10 studies were identified, of which 2 were preclinical studies, 1 was a clinical proof-of-concept study, 3 were clinical case reports, 1 was a completed clinical pilot study, and 3 were ongoing Phase I-Phase II clinical trials. For neuromodulatory FUS, 30 studies were identified, of which 19 were preclinical studies, 1 was a clinical case report, 4 were clinical pilot studies, and 6 were ongoing Phase I-Phase II clinical trials. Lastly, with respect to FUS-mediated blood-brain barrier (BBB) opening studies, 15 were identified, all of which were preclinical studies.</p><p><strong>Discussion: </strong>Currently, FUS has been clinically applied for targeted brain ablation (high intensity [HIFU]) and neuromodulation (low intensity [LIFU]), with recent basic science applications of sonogenetics and targeted drug delivery through the BBB (Precise Intracerebral Noninvasive Guided, or PING, Surgery) offering new opportunities for clinical translation. This review summarizes preclinical and clinical applications of FUS for epilepsy treatment, addresses challenges to implementation, and explores key areas for future research.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"166-188"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}