Focused Ultrasound Ablation for Neurological Disorders

Focused ultrasound (FUS) was explored for neurological indications more than half a century ago, but only recent technological advances have enabled its practical transcranial use for movement and neuropsychiatric disorders. FUS can produce stereotactic thermal lesions via FUS ablation (FUSA), while nonthermal lesioning (e.g., FUS histotripsy) and nonablative approaches such as neuromodulation and blood-brain barrier opening are under active clinical investigation. FUSA is approved by the Food and Drug Administration for essential tremor and Parkinson's disease (PD) and is now being evaluated for additional syndromes, including epilepsy, dystonia, and treatment-resistant psychiatric disorders. Neuroimaging, particularly magnetic resonance (MR) imaging and MR thermometry, is central to feasibility, targeting, intraprocedural monitoring, and posttreatment assessment. Clinical studies demonstrate substantial and durable motor symptom reduction in essential tremor and PD, with growing evidence for emerging indications. The goal of this review was to integrate mechanistic concepts with the current clinical evidence for FUSA and to define priorities that can improve patient selection, optimize targeting, and guide expansion across neurological and neuropsychiatric disorders.