Citation, DOI, disclosures and article data
Citation:
Gravino G, Campos A, Sharma R, et al. Deep brain ultrasound therapy. Reference article, Radiopaedia.org (Accessed on 07 Jul 2024) https://doi.org/10.53347/rID-50372
Deep brain ultrasound (DBUS) therapy, also known as transcranial MR-guided focused ultrasound (MRgFUS), is a form of precision medicine using a technique based on the principle of high-intensity focused ultrasound (HIFU), also referred to as focused ultrasound surgery (FUS).
Technique
The method combines two main components 1:
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guidance component
MRI of the head fixed into a stereotactic frame
use of a coordinates system to plan the ultrasound sonications by controlling the location and extent of thermal tissue destruction
MRI provides a unique ability to non-invasively map temperature
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therapeutic component
high power ultrasound is focused to a very small point creating particle vibrations that generate heat and subsequent cell death
temperatures above 56°C for 1-second result in irreversible cell death
for ultrasound ablation applications, the temperature ranges from 65°C to 100°C with minimal heating of adjacent tissues 2
The patient is awake throughout the procedure. A stereotactic frame (similar to that used in deep brain stimulation (DBS)) is fixed onto the head. With the patient lying supine, the frame then fits into a transducer which serves for transcranial focus of ultrasound waves. The transducer contains more than a thousand individually electronically controlled ultrasound elements. Between the scalp and the hemispheric transducer helmet lies a membrane of cooling water to dissipate heat and minimize the risk of burns.
The technique contrasts with surgical DBS which is an invasive procedure requiring incisions in the scalp, burr holes and insertion of electrodes into the brain. DBS is still undergoing a lot of research and trials to identify brain targets for different pathologies. Research in DBS will surely lend help to the application of DBUS, with the latter potentially gaining more prominence due to its non-invasive and lower risk profile 2.
Indications
DBUS has future potential for clinical neuropsychiatric applications:
essential tremor 3,4 (FDA and international approval); the primary target is the ventral intermediate nucleus (ViM) within the thalamus
Parkinson disease 5 (FDA and international approval); the thalamus is targeted for tremor, and the globus pallidus or subthalamic nucleus are targeted for dyskinesia
depression 6 (International approval but not FDA approved)
obsessive-compulsive disorder (OCD) 7 (international approval but not FDA approved)
chronic neuropathic pain 8 (international approval but not FDA approved)
brain tumors 9,10 (ongoing clinical trials)
drug-refractory epilepsy 22 (ongoing clinical trials)
reversible opening of the blood-brain-barrier to improve the delivery of drugs, gene therapy and even stem cells into target areas within the brain 11-14 (pre-clinical research)
HIFU is also being used and trialed for the treatment of extracranial pathology such as uterine fibroids (approved by FDA), breast cancer (cleared for use in multiple countries but not yet approved in the United States of America), and prostate cancer (cleared for use in multiple countries including the United States of America) 15-21.
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1. Kim Y, Rhim H, Choi M, Lim H, Choi D. High-Intensity Focused Ultrasound Therapy: An Overview for Radiologists. Korean J Radiol. 2008;9(4):291-302. doi:10.3348/kjr.2008.9.4.291 - Pubmed
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2. Halpern EJ. Science to Practice: High-intensity focused ultrasound ablation: will image-guided therapy replace conventional surgery?. Radiology. 235 (2): 345-6. doi:10.1148/radiol.2352041774 - Pubmed
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3. Elias W, Lipsman N, Ondo W et al. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med. 2016;375(8):730-9. doi:10.1056/NEJMoa1600159 - Pubmed
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4. Bond AE, Dallapiazza R, Huss D, Warren AL, Sperling S, Gwinn R, Shah BB, Elias WJ. A Randomized, Sham-Controlled Trial of Transcranial Magnetic Resonance-Guided Focused Ultrasound Thalamotomy Trial for the Treatment of Tremor-Dominant, Idiopathic Parkinson Disease. Neurosurgery. 63 Suppl 1: 154. doi:10.1227/01.neu.0000489702.18785.5f - Pubmed
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5. Schlesinger I, Eran A, Sinai A et al. MRI Guided Focused Ultrasound Thalamotomy for Moderate-To-Severe Tremor in Parkinson’s Disease. Parkinsons Dis. 2015;2015:1-4. doi:10.1155/2015/219149 - Pubmed
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6. Tsai S. Transcranial Focused Ultrasound as a Possible Treatment for Major Depression. Med Hypotheses. 2015;84(4):381-3. doi:10.1016/j.mehy.2015.01.030 - Pubmed
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7. Jung H, Kim S, Roh D et al. Bilateral Thermal Capsulotomy with MR-Guided Focused Ultrasound for Patients with Treatment-Refractory Obsessive-Compulsive Disorder: A Proof-Of-Concept Study. Mol Psychiatry. 2015;20(10):1205-11. doi:10.1038/mp.2014.154 - Pubmed
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8. Jeanmonod D, Werner B, Morel A et al. Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound: Noninvasive Central Lateral Thalamotomy for Chronic Neuropathic Pain. Neurosurg Focus. 2012;32(1):E1. doi:10.3171/2011.10.FOCUS11248 - Pubmed
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9. Coluccia D, Fandino J, Schwyzer L et al. First Noninvasive Thermal Ablation of a Brain Tumor with MR-Guided Focused Ultrasound. J Ther Ultrasound. 2014;2(1):17. doi:10.1186/2050-5736-2-17 - Pubmed
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10. McDannold N, Clement G, Black P, Jolesz F, Hynynen K. Transcranial Magnetic Resonance Imaging- Guided Focused Ultrasound Surgery of Brain Tumors: Initial Findings in 3 Patients. Neurosurgery. 2010;66(2):323-32; discussion 332. doi:10.1227/01.NEU.0000360379.95800.2F - Pubmed
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11. Fan C, Ting C, Lin C et al. Noninvasive, Targeted and Non-Viral Ultrasound-Mediated GDNF-Plasmid Delivery for Treatment of Parkinson’s Disease. Sci Rep. 2016;6(1):19579. doi:10.1038/srep19579 - Pubmed
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12. Hinow P, Radunskaya A, Mackay S et al. Signaled Drug Delivery and Transport Across the Blood-Brain Barrier. J Liposome Res. 2016;26(3):233-45. doi:10.3109/08982104.2015.1102277 - Pubmed
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13. Timbie K, Mead B, Price R. Drug and Gene Delivery Across the Blood-Brain Barrier with Focused Ultrasound. J Control Release. 2015;219:61-75. doi:10.1016/j.jconrel.2015.08.059 - Pubmed
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14. Park J, Zhang Y, Vykhodtseva N, Akula J, McDannold N. Targeted and Reversible Blood-Retinal Barrier Disruption via Focused Ultrasound and Microbubbles. PLoS One. 2012;7(8):e42754. doi:10.1371/journal.pone.0042754 - Pubmed
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15. Mahmoud M, Alkhorayef M, Alzimami K, Aljuhani M, Sulieman A. High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study. Pol J Radiol. 2014;79:384-90. doi:10.12659/PJR.891110 - Pubmed
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16. Merckel L, Bartels L, Köhler M et al. MR-Guided High-Intensity Focused Ultrasound Ablation of Breast Cancer with a Dedicated Breast Platform. Cardiovasc Intervent Radiol. 2013;36(2):292-301. doi:10.1007/s00270-012-0526-6 - Pubmed
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17. Furusawa H, Namba K, Nakahara H et al. The Evolving Non-Surgical Ablation of Breast Cancer: MR Guided Focused Ultrasound (MRgFUS). Breast Cancer. 2007;14(1):55-8. doi:10.2325/jbcs.14.55 - Pubmed
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18. Wu F, Wang Z, Cao Y et al. "Wide Local Ablation" of Localized Breast Cancer Using High Intensity Focused Ultrasound. J Surg Oncol. 2007;96(2):130-6. doi:10.1002/jso.20769 - Pubmed
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19. Uchida T, Tomonaga T, Kim H et al. Improved Outcomes with Advancements in High Intensity Focused Ultrasound Devices for the Treatment of Localized Prostate Cancer. J Urol. 2015;193(1):103-10. doi:10.1016/j.juro.2014.07.096 - Pubmed
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20. Crouzet S, Chapelon J, Rouvière O et al. Whole-Gland Ablation of Localized Prostate Cancer with High-Intensity Focused Ultrasound: Oncologic Outcomes and Morbidity in 1002 Patients. Eur Urol. 2014;65(5):907-14. doi:10.1016/j.eururo.2013.04.039 - Pubmed
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21. Crouzet S, Rebillard X, Chevallier D et al. Multicentric Oncologic Outcomes of High-Intensity Focused Ultrasound for Localized Prostate Cancer in 803 Patients. Eur Urol. 2010;58(4):559-66. doi:10.1016/j.eururo.2010.06.037 - Pubmed
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22. Lee C, Chou C, Hsiao F et al. Pilot Study of Focused Ultrasound for Drug-Resistant Epilepsy. Epilepsia. 2022;63(1):162-75. doi:10.1111/epi.17105 - Pubmed
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