Clinical application of transcranial magnetic resonance-guided focused ultrasound in the treatment of essential tremor
Objective To explore the clinical efficacy and safety of transcranial magnetic resonance-guided focused ultrasound(tcMRgFUS)in the treatment of essential tremor(ET).Methods The clinical data of 12 ET patients who underwent tcMRgFUS treatment at the Department of Neurosurgery,Neuromedicine Center,the University of Hong Kong-Shenzhen Hospital from September 2022 to June 2023 were retrospectively analyzed.The patient's age was 53.9±14.8 years(26-70 years);the disease duration was 26.2±15.6 years(6-50 years).The preoperative Clinical Rating Scale for Tremor(CRST)score of right hand[M(Q1,Q3)]was 15.0(11.3,22.3)points,and the Quality of Life in Essential Tremor Questionnaire(QUEST)score was 46.5(31.3,65.5)points.The effective skull area,skull density ratio(SDR),and the number of effective elements were evaluated before surgery;Spearman correlation analysis was used to evaluate the correlation between the skull area and the number of effective elements.All 12 patients had the ventral intermediate nucleus of the thalamus as the treatment target.Under MR thermal imaging monitoring,the preset focal spot temperature was 40 ℃ to 45 ℃ to align the target location and size,45 ℃ to 50 ℃ to verify effectiveness and safety,and 50 ℃ to 60 ℃ for ablation with a duration of 15-30 s.We observed and documented surgery-related complications.CRST was evaluated and head MR was reviewed on the 1st day,1 month,and 3 months after operation;QUEST was evaluated at 1 and 3 months after operation;and the improvement rate of the two scores was calculated.Results There was a positive correlation between the effective skull area(362±22 cm2)and the number of effective elements[M(Q1,Q3):948(927,978)]in 12 patients(r=0.63,P=0.029).The SDR value was 0.46±0.13.The operations were all completed successfully.The ablation temperature of 12 patients was(57.5±2.5)℃.The effective rate of treatment of tremor symptoms was 12/12.MR of 12 patients showed damaged lesions and surrounding edema 1 d after surgery.The center point of the edema region accurately matched the planned target point,and there was no deviation in position.A total of 15 mild adverse events occurred in 7 patients.Except for 1 patient whose taste change and numbness at the comers of the mouth did not improve,the symptoms of the other patients were relieved within 1 month after surgery.The follow-up time of 12 patients was 3 months.Compared with pre-operation,the CRST scores at 1 day after operation[M(Q1,Q3):1.5(0,2.0)points],1 month post operation[2.0(0,2.0)points],and 3 months post operations[2.0(1.0,2.0)points]were significantly different(x2=27.87,P＜0.001);the improvement rates were(90.8±8.7)％,(85.8±15.8)％and(77.5±21.6)％respectively.Compared with those before surgery,the difference in QUEST scores at 1 month[21.5(12.5,43.5)points]and 3 months[16.5(6.5,34.3)points]after surgery were statistically significant(x2=20.47,P＜0.001).The improvement rates were(49.5±29.0)％and(58.0±25.8)％respectively.All 12 patients underwent regular follow-up cranial MR after surgery,and it was found that the abnormal signals gradually shrank,indicating that the edema zone was gradually absorbed,and the diameter of the damaged lesions also gradually shrank.Conclusions The approach of tcMRgFUS can improve patients'tremor symptoms when treating ET.Surgery-related complications usually resolve within 1 month after surgery.The technology is relatively safe and effective.
Essential tremorMagnetic resonance imagingMR-guided focused ultrasoundSkull density ratioSonicationSonication spot
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