Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures

Area of Science:

• Neurosurgery
• Neurology
• Medical Imaging

Background:

• Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an FDA-approved, non-invasive treatment gaining traction for essential tremor (ET) and Parkinson's disease (PD).
• Initial clinical experiences with this procedure are crucial for understanding its long-term efficacy and safety profile.

Purpose of the Study:

• To evaluate the clinical outcomes and long-term follow-up of 160 consecutive MRgFUS thalamotomy cases.
• To assess the effectiveness in reducing tremor symptoms and the incidence and nature of side effects.

Main Methods:

• Retrospective chart review of patients undergoing unilateral MRgFUS thalamotomy.
• Assessment of tremor scores (CRST Part A) pre-operatively and at follow-up.
• Post-operative MRI to confirm lesion characteristics; side effect evaluation using Clavien-Dindo scale.

Main Results:

• 160 unilateral MRgFUS thalamotomies performed for ET (n=150) and PD (n=10).
• Significant and sustained reduction in resting and postural tremor in ET patients; intention tremor reduced by 78% at 2 years.
• Common acute side effects included imbalance (57%), sensory disturbances (25%), and dysmetria (11%), all mild and improving over time.

Conclusions:

• MRgFUS thalamotomy provides safe and effective long-term improvement for unilateral tremor symptoms.
• The most frequent side effects are temporary imbalance and sensory disturbances.
• This procedure represents a valuable non-invasive therapeutic option for medically refractory tremor disorders.