AUTHOR=Gallay Marc N. , Moser David , Federau Christian , Jeanmonod Daniel 

TITLE=Anatomical and Technical Reappraisal of the Pallidothalamic Tractotomy With the Incisionless Transcranial MR-Guided Focused Ultrasound. A Technical Note

JOURNAL=Frontiers in Surgery

VOLUME=Volume 6 - 2019

YEAR=2019

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2019.00002

DOI=10.3389/fsurg.2019.00002

ISSN=2296-875X

ABSTRACT=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 pre-planned target lesion sub-units of 1.5x1.5x3.0 mm, which were placed using focal point displace-ments 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.