Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor Under General Anesthesia: Technical Note

Authors

Kobina G. Mensah-Brown, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Andrew I. Yang, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Frederick L. Hitti, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Lenora Henry, Insightec Ltd, Dallas, Texas, USA.
Sabrina M. Heman-Ackah, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Hanane Chaibainou, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Gordon H. Baltuch, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Document Type

Article

Abstract

BACKGROUND: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an incisionless therapy for the treatment of medication-resistant essential tremor. Although its safety and efficacy has been demonstrated, MRgFUS is typically performed with the patient awake, with intraprocedural neurological assessments to guide lesioning. OBJECTIVE: To report the first case of MRgFUS thalamotomy under general anesthesia in a patient whose medical comorbidities prohibit him from being in a supine position without a secured airway. METHODS: The dentatorubrothalamic tract was directly targeted. Two sonications reaching lesional temperatures (≥54°C) were delivered without any complications. RESULTS: Lesioning was confirmed on intraoperative magnetic resonance imaging, and the patient experienced 89% improvement in his tremor postoperatively. CONCLUSION: This demonstrates the safety and feasibility of MRgFUS thalamotomy under general anesthesia without the benefit of intraprocedural neurological assessments.

Medical Subject Headings

Anesthesia, General; Essential Tremor (diagnostic imaging, surgery); Humans; Magnetic Resonance Imaging (methods); Magnetic Resonance Spectroscopy; Male; Thalamus (diagnostic imaging, surgery)

Publication Date

4-1-2022

Publication Title

Operative neurosurgery (Hagerstown, Md.)

E-ISSN

2332-4260

Volume

22

Issue

4

First Page

255

Last Page

260

PubMed ID

35147587

Digital Object Identifier (DOI)

10.1227/ONS.0000000000000119

Recommended Citation

Mensah-Brown, Kobina G.; Yang, Andrew I.; Hitti, Frederick L.; Henry, Lenora; Heman-Ackah, Sabrina M.; Chaibainou, Hanane; and Baltuch, Gordon H., "Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor Under General Anesthesia: Technical Note" (2022). Neurosurgery. 1876.
https://scholar.barrowneuro.org/neurosurgery/1876