Focused Ultrasound Thalamotomy for Essential Tremor in the Setting of a Ventricular Shunt: Technical Report

Authors

Andrew I. Yang, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Hanane Chaibainou, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Sumei Wang, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Frederick L. Hitti, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Brendan J. McShane, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
David Tilden, Insightec Ltd, Dallas, Texas.
Matthew Korn, Insightec Ltd, Dallas, Texas.
Aaron Blanke, Insightec Ltd, Dallas, Texas.
Mor Dayan, Insightec Ltd, Dallas, Texas.
Ronald L. Wolf, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Gordon H. Baltuch, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Document Type

Article

Abstract

BACKGROUND: A recent randomized controlled trial of magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) for essential tremor (ET) demonstrated safety and efficacy. Patients with ventricular shunts may be good candidates for FUS to minimize hardware-associated infections. OBJECTIVE: To demonstrate feasibility of FUS in this subset of patients. METHODS: A 74-yr-old male with medically refractory ET, and a right-sided ventricular shunt for normal pressure hydrocephalus, underwent FUS to the right ventro-intermedius (VIM) nucleus. The VIM nucleus was directly targeted using deterministic tractography. Clinical outcomes were measured using the Clinical Rating Scale for Tremor. RESULTS: Shunt components required 6% of the total ultrasound transducer elements to be shut off. Eight therapeutic sonications were delivered (maximum temperature, 64°), leading to a 90% improvement in hand tremor and a 100% improvement in functional disability at the 3-mo follow-up. No complications were noted. CONCLUSION: This is the first case of FUS thalamotomy in a patient with a shunt. Direct VIM targeting and achievement of therapeutic temperatures with acoustic energy is feasible in this subset of patients.

Medical Subject Headings

Aged; Essential Tremor (complications, surgery); High-Intensity Focused Ultrasound Ablation (methods); Humans; Hydrocephalus, Normal Pressure (complications, surgery); Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Surgery, Computer-Assisted; Thalamus (surgery); Treatment Outcome; Ventral Thalamic Nuclei (surgery); Ventriculoperitoneal Shunt

Publication Date

10-1-2019

Publication Title

Operative neurosurgery (Hagerstown, Md.)

E-ISSN

2332-4260

Volume

17

Issue

4

First Page

376

Last Page

381

PubMed ID

30888021

Digital Object Identifier (DOI)

10.1093/ons/opz013

Recommended Citation

Yang, Andrew I.; Chaibainou, Hanane; Wang, Sumei; Hitti, Frederick L.; McShane, Brendan J.; Tilden, David; Korn, Matthew; Blanke, Aaron; Dayan, Mor; Wolf, Ronald L.; and Baltuch, Gordon H., "Focused Ultrasound Thalamotomy for Essential Tremor in the Setting of a Ventricular Shunt: Technical Report" (2019). Neurosurgery. 1867.
https://scholar.barrowneuro.org/neurosurgery/1867