Noninvasive functional neurosurgery using transcranial MR imaging-guided focused ultrasound.
Noninvasive functional neurosurgery using transcranial MR imaging-guided focused ultrasound.
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DOI：
10.1016/s1353-8020(13)70046-4
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发表时间：
2014-01-01
影响因子：
4.1
通讯作者：
Werner, Beat
中科院分区：
文献类型：
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作者：
Bauer, Ronald;Martin, Ernst;Werner, Beat
未经标记：经颅磁共振成像引导聚焦超声（tcMRgFUS）是一种新技术，以补充已建立的神经外科干预措施的频谱。与传统的烧蚀手术相比，tcMRgFUS是无创的，完全是成像引导的，可以实时测量目标周围的连续温度。它没有轨迹限制，也不涉及电离辐射。由于没有设备被植入大脑或身体，未来的磁共振成像诊断工作没有限制。通过精确地将超声能量聚焦到丘脑、丘脑下和基底神经节的预期目标，同时避免附带组织损伤，治疗各种慢性、治疗抵抗性神经系统疾病的能力无疑是有吸引力的。正在进行的对130多名神经性疼痛、特发性震颤、帕金森病和强迫症患者的临床研究非常有希望，并证明超声能量可以精确地集中在完整的头骨上，而不会使其过热。临床前研究表明，改变超声参数不仅可以消融病理组织，或使功能失调的神经回路沉默，还可以调节神经功能。结论：经颅磁共振成像引导的聚焦超声是治疗难治性运动障碍（如原发性震颤和帕金森病）患者的一种新颖、无创的替代治疗选择。
UNLABELLED: Transcranial magnetic resonance imaging-guided focused ultrasound (tcMRgFUS) is a novel technique to supplement the spectrum of established neurosurgical interventions. In contrast to traditional ablative procedures, tcMRgFUS is noninvasive and entirely imaging-guided with continuous temperature measurements at and around the target in real time. It has no trajectory restrictions and does not involve ionizing radiation. Since no device is implanted into the brain or the body, there is no restriction to future diagnostic work-up with MR imaging. The ability to treat a variety of chronic, therapy-resistant neurological diseases by precisely focusing ultrasound energy to desired targets in the thalamus, subthalamus and basal ganglia while avoiding collateral tissue damage is certainly attractive. Ongoing clinical studies on over 130 patients with neuropathic pain, essential tremor, Parkinson's disease and obsessive-compulsive disorder are very promising and demonstrate that ultrasound energy can precisely be focused through the intact skull, without overheating it. Varying the ultrasound parameters allows not only to ablate pathological tissue, or silence dysfunctional neuronal circuits, but also to modulate neural functions, as shown in preclinical studies.CONCLUSION: Transcranial magnetic resonance imaging-guided focused ultrasound is a novel, noninvasive, alternative treatment option for patients with therapy-resistant movement disorders, such as essential tremor and Parkinson's disease.