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Research paper
Unilateral magnetic resonance guided focused ultrasound thalamotomy for essential tremor: practices and clinicoradiological outcomes
  1. Won Seok Chang1,
  2. Hyun Ho Jung1,
  3. Eun Jung Kweon1,
  4. Eyal Zadicario2,
  5. Itay Rachmilevitch2,
  6. Jin Woo Chang1
  1. 1Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
  2. 2Insightec, Ltd., Tirat Carmel, Israel
  1. Correspondence to Professor Jin Woo Chang, Department of Neurosurgery, Yonsei University College of Medicine, 205 Seongsanno, Seodaemun-gu Seoul 120–752, Republic of Korea; jchang{at}yuhs.ac

Abstract

Background Several options exist for surgical management of essential tremor (ET), including radiofrequency lesioning, deep brain stimulation and γ knife radiosurgery of the ventralis intermedius nucleus of the thalamus. Recently, magnetic resonance-guided focused ultrasound (MRgFUS) has been developed as a less-invasive surgical tool aimed to precisely generate focal thermal lesions in the brain.

Methods Patients underwent tremor evaluation and neuroimaging study at baseline and up to 6 months after MRgFUS. Tremor severity and functional impairment were assessed at baseline and then at 1 week, 1 month, 3 months and 6 months after treatment. Adverse effects were also sought and ascertained by directed questions, neuroimaging results and neurological examination.

Results The current feasibility study attempted MRgFUS thalamotomy in 11 patients with medication-resistant ET. Among them, eight patients completed treatment with MRgFUS, whereas three patients could not complete the treatment because of insufficient temperature. All patients who completed treatment with MRgFUS showed immediate and sustained improvements in tremors lasting for the 6-month follow-up period. Skull volume and maximum temperature rise were linearly correlated (linear regression, p=0.003). Other than one patient who had mild and delayed postoperative balance, no patient developed significant postsurgical complications; about half of the patients had bouts of dizziness during the MRgFUS.

Conclusions Our results demonstrate that MRgFUS thalamotomy is a safe, effective and less-invasive surgical method for treating medication-refractory ET. However, several issues must be resolved before clinical application of MRgFUS, including optimal patient selection and management of patients during treatment.

  • MRI
  • Surgery
  • Tremor
  • Ultrasound

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