Abstract
Functional disorders of the central nervous system (CNS) are diverse in terms of their etiology and symptoms, however, they can be quite debilitating. Many functional neurological disorders can progress to a level where pharmaceuticals and other early lines of treatment can no longer optimally treat the condition, therefore requiring surgical intervention. A variety of stereotactic and functional neurosurgical approaches exist, including deep brain stimulation, implantation, stereotaxic lesions, and radiosurgery, among others. Most techniques are invasive or minimally invasive forms of surgical intervention and require immense precision to effectively modulate CNS circuitry. Focused ultrasound (FUS) is a relatively new, safe, non-invasive neurosurgical approach that has demonstrated efficacy in treating a range of functional neurological diseases. It can function reversibly, through mechanical stimulation causing circuitry changes, or irreversibly, through thermal ablation at low and high frequencies respectively. In preliminary studies, magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) has been shown to have long-lasting treatment effects in several disease types. The technology has been approved by the FDA and internationally for a number of treatment-resistant neurological disorders and currently clinical trials are underway for several other neurological conditions. In this review, the authors discuss the potential applications and emerging role of MRgHIFU in functional neurosurgery in the coming years.
Highlights
BackgroundFunctional neurosurgery is unique in its focus on altering specific central nervous system (CNS) circuitry
The range of techniques utilized in functional neurosurgery are almost as diverse as the diseases they target, but most function through irreversible ablation or modulation
We explore the use of magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) to treat a variety of disorders including neuropathic pain, essential tremor, Parkinson’s disease, obsessive compulsive disorder, depression, trigeminal neuralgia, and epilepsy
Summary
Functional neurosurgery is unique in its focus on altering specific central nervous system (CNS) circuitry. Jeanmonod et al (2012) reported neuropathic pain relief in 11 patients treated with MRgHIFU by 49% at three months post-treatment and 57% at one year [27]. Additional protocol precautions involving measures to detect cavitation and limiting the thermogenesis of sonication to less than 60°C were subsequently implemented [16] While these studies were small, they suggest that MRgHIFU does offer an effective non-invasive method for treating refractory chronic neuropathic pain. The blood-brain barrier (BBB), a semipermeable membrane made up of endothelial tight junctions, lines the cerebral vasculature to prevent substances from readily passing into cells from the intravascular space While it does serve an extremely important function by preventing toxins and other damaging substances from entering the brain, it poses a challenge when designing medications as it can be difficult to create pharmaceuticals that cross the BBB to induce their desired effect. Additional studies are required to establish the viability of using MRgHIFU to modulate BBB permeability for treating diverse neurological and oncological diseases
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