TY - JOUR
T1 - Ultrasound Ablation in Neurosurgery
T2 - Current Clinical Applications and Future Perspectives
AU - Franzini, Andrea
AU - Moosa, Shayan
AU - Prada, Francesco
AU - Elias, W. Jeffrey
N1 - Publisher Copyright:
Copyright © 2019 by the Congress of Neurological Surgeons.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - The concept of focusing high-intensity ultrasound beams for the purpose of cerebral ablation has interested neurosurgeons for more than 70 yr. However, the need for a craniectomy or a cranial acoustic window hindered the clinical diffusion of this technique. Recent technological advances, including the development of phased-Array transducers and magnetic resonance imaging technology, have rekindled the interest in ultrasound for ablative brain surgery and have led to the development of the transcranial magnetic resonance-guided focused ultrasound (MRgFUS) thermal ablation procedure. In the last decade, this method has become increasingly popular, and its clinical applications are broadening. Despite the demonstrated efficacy of MRgFUS, transcranial thermal ablation using ultrasound is limited in that it can target exclusively the central region of the brain where the multiple acoustic beams are most optimally focused. On the contrary, lesioning of the cortex, the superficial subcortical areas, and regions close to the skull base is not possible with the limited treatment envelope of current phased-Array transducers. Therefore, new ultrasound ablative techniques, which are not based on thermal mechanisms, have been developed and tested in experimental settings. This review describes the mechanisms by which these novel, nonthermal ablative techniques are based and also presents the current clinical applications of MRgFUS thermal ablation.
AB - The concept of focusing high-intensity ultrasound beams for the purpose of cerebral ablation has interested neurosurgeons for more than 70 yr. However, the need for a craniectomy or a cranial acoustic window hindered the clinical diffusion of this technique. Recent technological advances, including the development of phased-Array transducers and magnetic resonance imaging technology, have rekindled the interest in ultrasound for ablative brain surgery and have led to the development of the transcranial magnetic resonance-guided focused ultrasound (MRgFUS) thermal ablation procedure. In the last decade, this method has become increasingly popular, and its clinical applications are broadening. Despite the demonstrated efficacy of MRgFUS, transcranial thermal ablation using ultrasound is limited in that it can target exclusively the central region of the brain where the multiple acoustic beams are most optimally focused. On the contrary, lesioning of the cortex, the superficial subcortical areas, and regions close to the skull base is not possible with the limited treatment envelope of current phased-Array transducers. Therefore, new ultrasound ablative techniques, which are not based on thermal mechanisms, have been developed and tested in experimental settings. This review describes the mechanisms by which these novel, nonthermal ablative techniques are based and also presents the current clinical applications of MRgFUS thermal ablation.
KW - Ablation
KW - Brain
KW - Image-guided surgery
KW - Lesioning surgery
KW - Magnetic resonance-guided focused ultrasound
KW - Stereotactic surgery
UR - http://www.scopus.com/inward/record.url?scp=85086496790&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85086496790&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyz407
DO - 10.1093/neuros/nyz407
M3 - Review article
C2 - 31745558
AN - SCOPUS:85086496790
VL - 87
SP - 1
EP - 10
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 1
ER -