| Transcranial magnetic resonance imaging-guided focused ultrasound: noninvasive central lateral thalamotomy for chronic neuropathic pain. | |
| | |
MedLine Citation:
|
PMID: 22208894 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
|
Object Recent technological developments open the field of therapeutic application of focused ultrasound to the brain through the intact cranium. The goal of this study was to apply the new transcranial magnetic resonance imaging-guided focused ultrasound (tcMRgFUS) technology to perform noninvasive central lateral thalamotomies (CLTs) as a treatment for chronic neuropathic pain. Methods In 12 patients suffering from chronic therapy-resistant neuropathic pain, tcMRgFUS CLT was proposed. In 11 patients, precisely localized thermal ablations of 3-4 mm in diameter were produced in the posterior part of the central lateral thalamic nucleus at peak temperatures between 51°C and 64°C with the aid of real-time patient monitoring and MR imaging and MR thermometry guidance. The treated neuropathic pain syndromes had peripheral (5 patients) or central (6 patients) origins and covered all body parts (face, arm, leg, trunk, and hemibody). Results Patients experienced mean pain relief of 49% at the 3-month follow-up (9 patients) and 57% at the 1-year follow-up (8 patients). Mean improvement according to the visual analog scale amounted to 42% at 3 months and 41% at 1 year. Six patients experienced immediate and persisting somatosensory improvements. Somatosensory and vestibular clinical manifestations were always observed during sonication time because of ultrasound-based neuronal activation and/or initial therapeutic effects. Quantitative electroencephalography (EEG) showed a significant reduction in EEG spectral overactivities. Thermal ablation sites showed sharply delineated ellipsoidal thermolesions surrounded by short-lived vasogenic edema. Lesion reconstructions (18 lesions in 9 patients) demonstrated targeting precision within a millimeter for all 3 coordinates. There was 1 complication, a bleed in the target with ischemia in the motor thalamus, which led to the introduction of 2 safety measures, that is, the detection of a potential cavitation by a cavitation detector and the maintenance of sonication temperatures below 60°C. Conclusions The authors assert that tcMRgFUS represents a noninvasive, precise, and radiation-free neurosurgical technique for the treatment of neuropathic pain. The procedure avoids mechanical brain tissue shift and eliminates the risk of infection. The possibility of applying sonication thermal spots free from trajectory restrictions should allow one to optimize target coverage. The real-time continuous MR imaging and MR thermometry monitoring of targeting accuracy and thermal effects are major factors in optimizing precision, safety, and efficacy in an outpatient context. |
| | |
Authors:
|
Daniel Jeanmonod; Beat Werner; Anne Morel; Lars Michels; Eyal Zadicario; Gilat Schiff; Ernst Martin |
Related Documents
:
|
18996264 - Mr-guided direct arthrography of the glenohumeral joint. 21795374 - The incremental value of spect/ct in characterizing solitary spine lesions. 17005774 - Sympathetic skin response: monitoring of ct-guided lumbar sympathetic blocks. 7971584 - Quantitative computer-assisted image analysis of suction biopsy in pediatric gastroesop... 21533864 - Accuracy of coronary artery stenosis detection with ct versus conventional coronary ang... 19504114 - Comparison of native axial radiographs with axial mr imaging for determination of the t... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Neurosurgical focus Volume: 32 ISSN: 1092-0684 ISO Abbreviation: Neurosurg Focus Publication Date: 2012 Jan |
Date Detail:
|
Created Date: 2012-01-02 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 100896471 Medline TA: Neurosurg Focus Country: United States |
Other Details:
|
Languages: eng Pagination: E1 Citation Subset: IM |
Affiliation:
|
Department of Functional Neurosurgery and. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Pollen processing behavior of Heliconius butterflies: a derived grooming behavior.
Next Document: Measurement of targeting accuracy in focused ultrasound functional neurosurgery.