2022 Volume 31 Issue 7 Pages 454-463
The history of tremor surgery began with radiofrequency (RF) thalamotomy by Hassler in 1954, and deep brain stimulation (DBS) therapy replaced it as the gold standard for tremor surgery as soon as Benabid developed it in 1987. Elias reported the treatment of essential tremor (ET) with MRI-guided focused ultrasound therapy (MRgFUS) in 2010, after which ablation surgery has been revived rapidly.
ExAblate Neuro 4000® is a piece of stereotactic neurosurgical equipment that can make an ablation lesion without craniotomy under monitoring the coagulation site and temperature. Although it is a high-precision surgical device, the success or failure of treatment depends largely on the skull density ratio (SDR) and the location of the target. For ET, SDR 0.4 or higher is desirable ; the highest clinical effect is obtained at a coagulation temperature of 55-56℃, and bilateral surgery could be possible. The posteroventral pallidum is a target for dyskinesia in Parkinson's disease (PD). However, the optimal target for PD with MRgFUS is controversial. It is also clinically applied to other brain tumors, stroke, obsessive-compulsive disorder, hamartoma, etc. The reversible opening of the blood-brain barrier by the combination of ultrasound and microbubbles is expected to be a breakthrough in the treatment of intractable neurological diseases.
