Magnetic resonance-guided focused ultrasound for movement disorders: clinical and neuroimaging advances.

Abstract

To describe the path of technological developments that have led to the actual application of MRI-guided focused ultrasound in multiple neurological disorders and to update the more recent technical advances in the field. An insight into the latest clinical achievements in movement disorders will be provided, together with the neuroimaging advances for the screening, planning, and outcome evaluation. Developments, such as phased array transducers and MRI guidance have allowed the use of focused ultrasound to successfully perform incisionless therapeutic ablation in deep brain structures. Although its indication through a thalamotomy has been approved for essential and parkinsonian tremor, it has also shown preliminary efficacy for other types of tremor, Parkinson's disease motor signs and neuropsychiatric disorders. In parallel, neuroradiological techniques have helped to improve treatment application and provided new evidence in terms of lesion topography, impact on distant structures and understanding of action mechanisms. Neuroimaging developments have helped to increase successful applications of focused ultrasound as a minimally invasive ablative approach and to understand the mechanisms by which ablation of a certain brain region improves neurological disorders. The field is expanding rapidly and in the coming years it will transform functional neurosurgery.