PMID- 37010324
OWN - NLM
STAT- MEDLINE
DCOM- 20230816
LR  - 20240404
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Print)
IS  - 0148-396X (Linking)
VI  - 93
IP  - 3
DP  - 2023 Sep 1
TI  - A Systematic Review Comparing Focused Ultrasound Surgery With Radiosurgery for 
      Essential Tremor.
PG  - 524-538
LID - 10.1227/neu.0000000000002462 [doi]
AB  - BACKGROUND: Focused ultrasound (FUS-T) and stereotactic radiosurgery thalamotomy 
      (SRS-T) targeting the ventral intermediate nucleus are effective incisionless 
      surgeries for essential tremor (ET). However, their efficacy for tremor reduction 
      and, importantly, adverse event incidence have not been directly compared. 
      OBJECTIVE: To present a comprehensive systematic review with network 
      meta-analysis examining both efficacy and adverse events (AEs) of FUS-T vs SRS-T 
      for treating medically refractory ET. METHODS: We conducted a systematic review 
      and network meta-analysis according to the Preferred Reporting Items for 
      Systematic Reviews and Meta-Analyses guidelines, using the PubMed and Embase 
      databases. We included all primary FUS-T/SRS-T studies with approximately 1-year 
      follow-up, with unilateral Fahn-Tolosa-Marin Tremor Rating Scale or Clinical 
      Rating Scale for Tremor scores prethalamotomy/post-thalamotomy and/or AEs. The 
      primary efficacy outcome was Fahn-Tolosa-Marin Tremor Rating Scale A+B score 
      reduction. AEs were reported as an estimated incidence. RESULTS: Fifteen studies 
      of 464 patients and 3 studies of 62 patients met inclusion criteria for 
      FUS-T/SRS-T efficacy comparison, respectively. Network meta-analysis demonstrated 
      similar tremor reduction between modalities (absolute tremor reduction: FUS-T: 
      -11.6 (95% CI: -13.3, -9.9); SRS-T: -10.3 (95% CI: -14.2, -6.0). FUS-T had a 
      greater 1-year adverse event rate, particularly imbalance and gait disturbances 
      (10.5%) and sensory disturbances (8.3%). Contralateral hemiparesis (2.7%) often 
      accompanied by speech impairment (2.4%) were most common after SRS-T. There was 
      no correlation between efficacy and lesion volume. CONCLUSION: Our systematic 
      review found similar efficacy between FUS-T and SRS-T for ET, with trend toward 
      higher efficacy yet greater adverse event incidence with FUS-T. Smaller lesion 
      volumes could mitigate FUS-T off-target effects for greater safety.
CI  - Copyright (c) Congress of Neurological Surgeons 2023. All rights reserved.
FAU - Kondapavulur, Sravani
AU  - Kondapavulur S
AUID- ORCID: 0000-0002-4412-5978
AD  - Department of Neurological Surgery, UCSF, San Francisco , California , USA.
AD  - Medical Scientist Training Program, UCSF, San Francisco , California , USA.
FAU - Silva, Alexander B
AU  - Silva AB
AD  - Department of Neurological Surgery, UCSF, San Francisco , California , USA.
AD  - Medical Scientist Training Program, UCSF, San Francisco , California , USA.
FAU - Molinaro, Annette M
AU  - Molinaro AM
AD  - Department of Neurological Surgery, UCSF, San Francisco , California , USA.
FAU - Wang, Doris D
AU  - Wang DD
AUID- ORCID: 0000-0002-5336-1702
AD  - Department of Neurological Surgery, UCSF, San Francisco , California , USA.
LA  - eng
GR  - T32 GM007618/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, N.I.H., Extramural
PT  - Systematic Review
DEP - 20230403
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
EIN - Neurosurgery. 2024 Jan 1;94(1):e17. PMID: 37888997
MH  - Humans
MH  - *Essential Tremor/surgery
MH  - Magnetic Resonance Imaging
MH  - *Radiosurgery/adverse effects
MH  - Thalamus/surgery
MH  - Treatment Outcome
MH  - Tremor/surgery
MH  - *Ultrasonic Surgical Procedures
MH  - Network Meta-Analysis
PMC - PMC10553193
EDAT- 2023/04/04 06:00
MHDA- 2023/08/16 06:43
PMCR- 2024/04/03
CRDT- 2023/04/03 09:13
PHST- 2022/11/16 00:00 [received]
PHST- 2023/01/26 00:00 [accepted]
PHST- 2023/08/16 06:43 [medline]
PHST- 2023/04/04 06:00 [pubmed]
PHST- 2023/04/03 09:13 [entrez]
PHST- 2024/04/03 00:00 [pmc-release]
AID - 00006123-202309000-00006 [pii]
AID - NEU-D-22-01552 [pii]
AID - 10.1227/neu.0000000000002462 [doi]
PST - ppublish
SO  - Neurosurgery. 2023 Sep 1;93(3):524-538. doi: 10.1227/neu.0000000000002462. Epub 
      2023 Apr 3.