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Brain-focussed ultrasound: what's the "FUS" all about? A review of current and emerging neurological applications.

ABSTRACT: MR-guided focussed ultrasound surgery (MRgFUS) allows for precise non-invasive thermal ablation of target tissues for a wide range of clinical applications. It is an innovative and rapidly expanding technology, which has already established itself as an effective and safe incisionless alternative in the treatment of various soft tissue tumours, with many more research studies underway to extend its therapeutic envelope. The non-invasiveness of the procedure makes FUS particularly attractive in functional neurosurgery, where existing treatment options are not suitable for all patients. Several clinical trials have demonstrated the feasibility and favourable safety profile of MR-guided focused ultrasound surgery in essential tremor, Parkinson's disease and other neurological conditions. This article reviews the existing evidence base for the neurological applications of FUS and the evidence for its emerging roles in the treatment of a range of brain disorders.

SUBMITTER: Bretsztajn L

PROVIDER: S-EPMC6221771 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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Brain-focussed ultrasound: what's the "FUS" all about? A review of current and emerging neurological applications.

Bretsztajn Laure L Gedroyc Wladyslaw W

The British journal of radiology 20180306 1087

MR-guided focussed ultrasound surgery (MRgFUS) allows for precise non-invasive thermal ablation of target tissues for a wide range of clinical applications. It is an innovative and rapidly expanding technology, which has already established itself as an effective and safe incisionless alternative in the treatment of various soft tissue tumours, with many more research studies underway to extend its therapeutic envelope. The non-invasiveness of the procedure makes FUS particularly attractive in f ...[more]

PMID: 29419328

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Project description:Background and purposeOncological neurosurgery relies heavily on making continuous, intra-operative tumor-brain delineations based on image-guidance. Limitations of currently available imaging techniques call for the development of real-time image-guided resection tools, which allow for reliable functional and anatomical information in an intra-operative setting. Functional ultrasound (fUS), is a new mobile neuro-imaging tool with unprecedented spatiotemporal resolution, which allows for the detection of small changes in blood dynamics that reflect changes in metabolic activity of activated neurons through neurovascular coupling. We have applied fUS during conventional awake brain surgery to determine its clinical potential for both intra-operative functional and vascular brain mapping, with the ultimate aim of achieving maximum safe tumor resection.MethodsDuring awake brain surgery, fUS was used to image tumor vasculature and task-evoked brain activation with electrocortical stimulation mapping (ESM) as a gold standard. For functional imaging, patients were presented with motor, language or visual tasks, while the probe was placed over (ESM-defined) functional brain areas. For tumor vascular imaging, tumor tissue (pre-resection) and tumor resection cavity (post-resection) were imaged by moving the hand-held probe along a continuous trajectory over the regions of interest.ResultsA total of 10 patients were included, with predominantly intra-parenchymal frontal and temporal lobe tumors of both low and higher histopathological grades. fUS was able to detect (ESM-defined) functional areas deep inside the brain for a range of functional tasks including language processing. Brain tissue could be imaged at a spatial and temporal resolution of 300 μm and 1.5-2.0 ms respectively, revealing real-time tumor-specific, and healthy vascular characteristics.ConclusionThe current study presents the potential of applying fUS during awake brain surgery. We illustrate the relevance of fUS for awake brain surgery based on its ability to capture both task-evoked functional cortical responses as well as differences in vascular characteristics between tumor and healthy tissue. As current neurosurgical practice is still pre-dominantly leaning on inherently limited pre-operative imaging techniques for tumor resection-guidance, fUS enters the scene as a promising alternative that is both anatomically and physiologically informative.

Dataset Information

Brain-focussed ultrasound: what's the "FUS" all about? A review of current and emerging neurological applications.

Publications

Brain-focussed ultrasound: what's the "FUS" all about? A review of current and emerging neurological applications.

Similar Datasets

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