Focused ultrasound ablation as tremor treatment

Abstract

The development of high-intensity magnetic resonance imaging (MRI)-guided focused ultrasound (MRIgFUS) ablation has widened the spectrum of interventional techniques for stereotactic functional neurosurgery of lesions. This has resulted in novel incisionless intervention approaches for the therapy of tremor disorders. The safety and efficacy is documented by recent study data. This article encompasses adescription of the technological basis and typical course of MRIgFUS interventions, acomparison to alternative open or incisionless surgical techniques as well as areview of the current evidence base for MRIgFUS ablation in the context of lesional interventions to treat tremor. Narrative literature review and comparison. Depending on the surgical target and tremor etiology published trials of MRIgFUS ablation report areduction of tremor intensity of up to 80% after 6-12months follow-up without the disadvantages of open brain surgery. The MRIgFUS functional neurosurgery is conducted only at alimited number of treatment sites. First data on lesions of the thalamic ventral intermediary nucleus (V.im.) as well as subthalamic fiber tracts have been published. These results indicate an effective and safe treatment of tremor disorders by MRIgFUS ablation. Incisionless lesional surgery using MRIgFUS is asignificant addition to the interventional armamentarium for functional stereotactic neurosurgery and apotentially valuable alternative to established interventional therapy options for tremor disorders.