PMID- 29385921
OWN - NLM
STAT- MEDLINE
DCOM- 20191014
LR  - 20191014
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 44
IP  - 2
DP  - 2018 Feb
TI  - Volumetric analysis of magnetic resonance-guided focused ultrasound thalamotomy 
      lesions.
PG  - E6
LID - 2017.11.FOCUS17587 [pii]
LID - 10.3171/2017.11.FOCUS17587 [doi]
AB  - OBJECTIVE Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy was 
      recently approved for use in the treatment of medication-refractory essential 
      tremor (ET). Previous work has described lesion appearance and volume on MRI up 
      to 6 months after treatment. Here, the authors report on the volumetric 
      segmentation of the thalamotomy lesion and associated edema in the immediate 
      postoperative period and 1 year following treatment, and relate these 
      radiographic characteristics with clinical outcome. METHODS Seven patients with 
      medication-refractory ET underwent MRgFUS thalamotomy at Brigham and Women's 
      Hospital and were monitored clinically for 1 year posttreatment. Treatment effect 
      was measured using the Clinical Rating Scale for Tremor (CRST). MRI was performed 
      immediately postoperatively, 24 hours posttreatment, and at 1 year. Lesion 
      location and the volumes of the necrotic core (zone I) and surrounding edema 
      (cytotoxic, zone II; vasogenic, zone III) were measured on thin-slice T2-weighted 
      images using Slicer 3D software. RESULTS Patients had significant improvement in 
      overall CRST scores (baseline 51.4 +/- 10.8 to 24.9 +/- 11.0 at 1 year, p = 0.001). 
      The most common adverse events (AEs) in the 1-month posttreatment period were 
      transient gait disturbance (6 patients) and paresthesia (3 patients). The center 
      of zone I immediately posttreatment was 5.61 +/- 0.9 mm anterior to the posterior 
      commissure, 14.6 +/- 0.8 mm lateral to midline, and 11.0 +/- 0.5 mm lateral to the 
      border of the third ventricle on the anterior commissure-posterior commissure 
      plane. Zone I, II, and III volumes immediately posttreatment were 0.01 +/- 0.01, 
      0.05 +/- 0.02, and 0.33 +/- 0.21 cm(3), respectively. These volumes increased 
      significantly over the first 24 hours following surgery. The edema did not spread 
      evenly, with more notable expansion in the superoinferior and lateral directions. 
      The spread of edema inferiorly was associated with the incidence of gait 
      disturbance. At 1 year, the remaining lesion location and size were comparable to 
      those of zone I immediately posttreatment. Zone volumes were not associated with 
      clinical efficacy in a statistically significant way. CONCLUSIONS MRgFUS 
      thalamotomy demonstrates sustained clinical efficacy at 1 year for the treatment 
      of medication-refractory ET. This technology can create accurate, predictable, 
      and small-volume lesions that are stable over time. Instances of AEs are 
      transient and are associated with the pattern of perilesional edema expansion. 
      Additional analysis of a larger MRgFUS thalamotomy cohort could provide more 
      information to maximize clinical effect and reduce the rate of long-lasting AEs.
FAU - Harary, Maya
AU  - Harary M
AD  - Departments of1Neurosurgery and.
FAU - Essayed, Walid I
AU  - Essayed WI
AD  - Departments of1Neurosurgery and.
FAU - Valdes, Pablo A
AU  - Valdes PA
AD  - Departments of1Neurosurgery and.
FAU - McDannold, Nathan
AU  - McDannold N
AD  - 2Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, 
      Massachusetts.
FAU - Cosgrove, G Rees
AU  - Cosgrove GR
AD  - Departments of1Neurosurgery and.
LA  - eng
GR  - P01 CA174645/CA/NCI NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Aged
MH  - Cohort Studies
MH  - Essential Tremor/*diagnostic imaging/*surgery
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging/*methods
MH  - Male
MH  - Middle Aged
MH  - Thalamus/*diagnostic imaging/*surgery
MH  - Ultrasonography, Interventional/*methods
OTO - NOTNLM
OT  - AC = anterior commissure
OT  - AE = adverse event
OT  - AP = anteroposterior
OT  - CRST = Clinical Rating Scale for Tremor
OT  - ET = essential tremor
OT  - FRFSE = fast relaxation fast spin echo
OT  - MRgFUS
OT  - MRgFUS = MR-guided focused ultrasound
OT  - PC = posterior commissure
OT  - PLIC = posterior limb of the internal capsule
OT  - ROC = receiver operating characteristic
OT  - SI = superoinferior
OT  - Vim = ventral intermediate nucleus of the thalamus
OT  - essential tremor
OT  - focused ultrasound
OT  - thalamotomy
OT  - volumetric segmentation
EDAT- 2018/02/02 06:00
MHDA- 2019/10/15 06:00
CRDT- 2018/02/02 06:00
PHST- 2018/02/02 06:00 [entrez]
PHST- 2018/02/02 06:00 [pubmed]
PHST- 2019/10/15 06:00 [medline]
AID - 2017.11.FOCUS17587 [pii]
AID - 10.3171/2017.11.FOCUS17587 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2018 Feb;44(2):E6. doi: 10.3171/2017.11.FOCUS17587.