Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders
Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders
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DOI：
10.1093/ons/opaa240
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发表时间：
2020-12-01
影响因子：
2.3
通讯作者：
Lipsman, Nir
中科院分区：
文献类型：
--
作者：
Davidson, Benjamin;Hamani, Clement;Lipsman, Nir
背景：精神科手术是功能神经外科的一个重要领域，涉及针对难治性精神疾病进行的深部脑刺激（DBS）或病变手术。最近可以使用磁引导聚焦超声（MRgFUS）进行双侧囊切开术，这是一种通常与外科射频消融或立体定向放射外科一起进行的病变技术。 MRgFUS 具有多种优势，包括提高安全性和病灶实时成像。 目的：描述对重度难治性抑郁症和强迫症患者进行双侧 MRgFUS 囊切开术的临床和技术方面。方法：我们描述进行 MRgFUS 囊切开术的临床和技术注意事项。讨论的主题包括患者选择、头架应用、定位、超声处理策略和后续程序。结果：16 名患者接受了 MRgFUS 囊切开术，没有发生严重的临床或放射学不良事件。结论：MRgFUS 为进行经过充分研究的精神科手术——前囊切开术提供了一种安全、微创的技术。
BACKGROUND: Psychiatric surgery is an important domain of functional neurosurgery and involves deep brain stimulation (DBS) or lesional procedures performed for treatment-resistant psychiatric illness. It has recently become possible to use magnetic-guided focused ultrasound (MRgFUS) to perform bilateral capsulotomy, a lesional technique commonly carried out with surgical radiofrequency ablation or stereotactic radiosurgery. MRgFUS offers several advantages, including improved safety and real-time imaging of the lesions.OBJECTIVE: To describe the clinical and technical aspects of performing bilateral MRgFUS capsulotomy in patients with severe refractory depression and obsessive-compulsive disorder.METHODS: We describe the clinical and technical considerations of performing MRgFUS capsulotomy. Topics discussed include patient selection, headframe application, targeting, sonication strategies, and follow-up procedures.RESULTS: MRgFUS capsulotomy was performed in 16 patients without serious clinical or radiographic adverse events.CONCLUSION: MRgFUS allows for a safe, less invasive technique for performing a well-studied psychiatric surgery procedure-the anterior capsulotomy.