Anatomical and Technical Reappraisal of the Pallidothalamic Tractotomy With the Incisionless Transcranial MR-Guided Focused Ultrasound. A Technical Note
Anatomical and Technical Reappraisal of the Pallidothalamic Tractotomy With the Incisionless Transcranial MR-Guided Focused Ultrasound. A Technical Note
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DOI：
10.3389/fsurg.2019.00002
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发表时间：
2019-01-24
影响因子：
1.8
通讯作者：
Jeanmonod, Daniel
中科院分区：
文献类型：
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作者：
Gallay, Marc N.;Moser, David;Jeanmonod, Daniel
背景：磁共振引导聚焦超声（MRgFUS）为安全有效的脑内病变提供了新的视角。在功能神经外科领域，靶区的覆盖问题一直是一个未得到最佳解决的问题。目的：应用磁共振gFUS技术对慢性难治性帕金森病（PD）患者进行苍白球丘脑神经束切断术（PTT），为PTT手术提供一个最佳的手术方案。分析了6个人脑半球的组织切片和地图，并在髓鞘染色切片上绘制并叠加了苍白球丘脑束的轮廓。我们确定了一个标准化的PTT目标覆盖范围，其特征在于5至7个预先计划的1.5 x 1.5 x 3.0 mm的靶病变亚单位，这些亚单位在热剂量控制下使用焦点位移和尽可能短的时间放置。在此，我们提出了我们目前的方法，MRgFUS PTT的基础上，组织学重新评估和优化的热应用于苍白球丘脑束在H1 Forel的领域
Background: MR-guided focused ultrasound (MRgFUS) offers new perspectives for safe and efficient lesioning inside the brain. The issue of target coverage remains primordial and sub-optimally addressed or solved in the field of functional neurosurgery.Objective: To provide an optimized planning and operative strategy to perform a pallidothalamic tractotomy (PTT) in chronic therapy-resistant Parkinson's disease (PD) with the technology of MRgFUS.Methods and results: Histological sections and maps from 6 human brain hemispheres were analyzed and outlines of the pallidothalamic tract on Myelin-stained sections were drawn and superimposed. We determined a standardized PTT target coverage characterized by 5 to 7 preplanned target lesion sub-units of 1.5 x 1.5 x 3.0 mm, which were placed using focal point displacements and shortest possible times, under thermal dose control.Conclusion: We hereby present our current approach to the MRgFUS PTT on the basis of a histological reappraisal and optimized heat application to the pallidothalamic tract in the H1 field of Forel.