About this Research Topic
Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is an innovative method of brain surgery that doesn't require opening the skull or penetrating the brain. Since the first study using MRgFUS in functional neurosurgery for neuropathic pain was published in 2009, there has been significant progress worldwide. The European CE mark for using the transcranial focused ultrasound system, ExAblate Neuro (Insightec Ltd), to treat neurological disorders in the brain, including essential tremor, Parkinson’s disease-related tremor, and neuropathic pain, was awarded in 2012. In 2016, the US Food and Drug Administration (FDA) approved it for the treatment of medically refractory essential tremors or Parkinson-related tremors. Since then, the worldwide adoption of MRgFUS, as a new treatment modality against tremors, has been incredibly fast indeed.
Compared to other techniques that involve cerebral penetration, MRgFUS has high targeting accuracy and a low side-effect profile. With targeting accuracy within one millimeter and no brain shift, this technique reduces the risk of placing a thermolesion away from the intended target. Additionally, intraoperative clinical assessments can be performed on awake patients to assess the clinical efficacy and potential side effects.
Motor thalamotomy, with the ventralis intermedius (VIM) nucleus as a target, is now routinely performed and has been adopted by many centers. However, MRgFUS remains a tool to perform therapeutic lesions accurately and safely. In this context, other clinical indications and, of necessity, other targets still need to be investigated to advantageously increase the neurosurgical armamentarium. Various targets are under investigation or in routine use in Parkinson's disease (pallidotomy, STN lesion, pallidothalamic tractotomy). In Essential tremor, the cerebellothalamic tract is known as an alternative target since the 1970s. Neuropathic pain is also treated routinely and is currently being investigated in several international studies. Preliminary results have also been published for obsessive-compulsive disorders. Pilot projects have already addressed the issue of dystonia.
As most neurological disorders affect both brain hemispheres, the issue of bilateral treatments needs to be investigated.
At a technical level, many points remain to be elucidated. What are the best targeting methods? How to control the best target coverage? How to overcome difficult skull morphologies?
The potential of MRgFUS is not limited to stereotactic lesions. The ability to temporarily open the blood-brain barrier to allow drugs to pass through will offer incredible treatment prospects for many neurological diseases. Additionally, many other applications of focused ultrasound are being conceptualized or investigated, such as sonoporation, controlled cavitation, immunomodulation, sensitization to radiotherapy, sonodynamic therapy, or liquid biopsy.
This Research Topic includes contributions from researchers and authors worldwide to better address this innovative issue.
Compared to other techniques that involve cerebral penetration, MRgFUS has high targeting accuracy and a low side-effect profile. With targeting accuracy within one millimeter and no brain shift, this technique reduces the risk of placing a thermolesion away from the intended target. Additionally, intraoperative clinical assessments can be performed on awake patients to assess the clinical efficacy and potential side effects.
Motor thalamotomy, with the ventralis intermedius (VIM) nucleus as a target, is now routinely performed and has been adopted by many centers. However, MRgFUS remains a tool to perform therapeutic lesions accurately and safely. In this context, other clinical indications and, of necessity, other targets still need to be investigated to advantageously increase the neurosurgical armamentarium. Various targets are under investigation or in routine use in Parkinson's disease (pallidotomy, STN lesion, pallidothalamic tractotomy). In Essential tremor, the cerebellothalamic tract is known as an alternative target since the 1970s. Neuropathic pain is also treated routinely and is currently being investigated in several international studies. Preliminary results have also been published for obsessive-compulsive disorders. Pilot projects have already addressed the issue of dystonia.
As most neurological disorders affect both brain hemispheres, the issue of bilateral treatments needs to be investigated.
At a technical level, many points remain to be elucidated. What are the best targeting methods? How to control the best target coverage? How to overcome difficult skull morphologies?
The potential of MRgFUS is not limited to stereotactic lesions. The ability to temporarily open the blood-brain barrier to allow drugs to pass through will offer incredible treatment prospects for many neurological diseases. Additionally, many other applications of focused ultrasound are being conceptualized or investigated, such as sonoporation, controlled cavitation, immunomodulation, sensitization to radiotherapy, sonodynamic therapy, or liquid biopsy.
This Research Topic includes contributions from researchers and authors worldwide to better address this innovative issue.
Keywords: Magnetic resonance-guided focused ultrasound, MRgFUS, tremors, Parkinson's disease
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