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Review
. 2018 Oct 4;33(44):e279.
doi: 10.3346/jkms.2018.33.e279. eCollection 2018 Oct 29.

Magnetic Resonance-Guided Focused Ultrasound in Neurosurgery: Taking Lessons from the Past to Inform the Future

Na Young Jung  1 , Jin Woo Chang  1
Affiliations
Review

Magnetic Resonance-Guided Focused Ultrasound in Neurosurgery: Taking Lessons from the Past to Inform the Future

Na Young Jung et al. J Korean Med Sci. .

Abstract

Magnetic resonance-guided focused ultrasound (MRgFUS) is a new emerging neurosurgical procedure applied in a wide range of clinical fields. It can generate high-intensity energy at the focal zone in deep body areas without requiring incision of soft tissues. Although the effectiveness of the focused ultrasound technique had not been recognized because of the skull being a main barrier in the transmission of acoustic energy, the development of hemispheric distribution of ultrasound transducer phased arrays has solved this issue and enabled the performance of true transcranial procedures. Advanced imaging technologies such as magnetic resonance thermometry could enhance the safety of MRgFUS. The current clinical applications of MRgFUS in neurosurgery involve stereotactic ablative treatments for patients with essential tremor, Parkinson's disease, obsessive-compulsive disorder, major depressive disorder, or neuropathic pain. Other potential treatment candidates being examined in ongoing clinical trials include brain tumors, Alzheimer's disease, and epilepsy, based on MRgFUS abilities of thermal ablation and opening the blood-brain barrier. With the development of ultrasound technology to overcome the limitations, MRgFUS is gradually expanding the therapeutic field for intractable neurological disorders and serving as a trail for a promising future in noninvasive and safe neurosurgical care.

Keywords: Ablation; High-Intensity Focused Ultrasound Ablation; Magnetic Resonance Imaging; Neurological Disorder; Neurosurgical Procedure.

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Conflict of interest statement

Disclosure: The authors have no potential conflicts of interest to disclose. NoteThis article is an invited review for Prof. Jin Woo Chang as the laureate of the 14th Bayer Prize in Clinical Medicine, 2018.

Figures

Fig. 1
Fig. 1. MRgFUS system for brain surgery. The main device is the Exablate 4000 device (InSightec, Tirat Carmel, Israel) in combination with 3-T MRI scanner (A). The head of the patient is fixed to a stereotactic frame and assembled with a MRI machine (B).
MRgFUS = magnetic resonance-guided focused ultrasound, MRI = MR imaging.
Fig. 2
Fig. 2. Flow chart of procedure using MRgFUS ablation.
MRgFUS = magnetic resonance-guided focused ultrasound.
Fig. 3
Fig. 3. Brain magnetic resonance images after the ablation procedure using MRgFUS. Well-defined small lesions are identified (white arrows) on T2 weighted imaging after unilateral thalamotomy for ET (A), unilateral pallidotomy for PD (B), bilateral capsulotomy for psychological disease (C).
MRgFUS = magnetic resonance-guided focused ultrasound, ET = essential tremor, PD = Parkinson's disease.
See this image and copyright information in PMC

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