Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor Under General Anesthesia: Technical Note. Issue 4 (11th April 2022)

• Record Type: Journal Article
• Authors: Mensah-Brown, Kobina G.; Yang, Andrew I.; Hitti, Frederick L.; Henry, Lenora; Heman-Ackah, Sabrina M.; Chaibainou, Hanane; Baltuch, Gordon H.
• Is Part Of: Operative neurosurgery. Volume 22:Issue 4(2022)
• Page Start: 255
• Page End: 260
• Publication Date: 2022-04-11
• Subjects: Magnetic resonance–guided focused ultrasound -- General anesthesia; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1227/ONS.0000000000000119
• Languages: English
• ISSNs: 2332-4252

Abstract

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.