mri-guided-focused-ultrasound-thalamotomy-for-patients-with-medically

MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor

Essential tremor (ET) is the most common type of tremor in adults. While ET does not result in decreased life expectancy, the disabilities associated with ...

Sunnybrook Health Sciences Centre

Breast fibroadenomata (FAD) are benign lesions which occur in about 10 % of all women. Diagnosis is made by triple assessment (physical examination, imaging and/or histopathology/cytology). For a definitive diagnosis of FAD, the treatment is conservative unless the patient is symptomatic. For symptomatic patients, the lumps can be surgically excised or removed interventionally by vacuum-assisted mammotomy (VAM). Ablative techniques like high-intensity focused ultrasound (HIFU), cryo-ablation and laser ablation have also been used for the treatment of FAD, providing a minimally invasive treatment without scarring or poor cosmesis. This review summarises current trials using minimally invasive ablative techniques in the treatment of breast FAD.

A review of ablative techniques in the treatment of breast fibroadenomata.

Uncontrolled pilot studies have suggested the efficacy of focused ultrasound thalamotomy with magnetic resonance imaging (MRI) guidance for the treatment of essential tremor.

A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor.

Modern neurosurgical training is both physically and emotionally demanding, posing significant challenges, new and old, to residents as well as programs attempting to train safe, competent surgeons. Models to describe resident development, such as the Accreditation Council for Graduate Medical Education competencies and milestones, address the acquisition of specific skills but largely ignore the stresses and pressures unique to each stage of resident training.

"The Actualized Neurosurgeon": A Proposed Model of Surgical Resident Development.

Anorexia nervosa is a life-threatening illness. Brain circuits believed to drive anorexia nervosa symptoms can be accessed with surgical techniques such as deep brain stimulation (DBS). Initial results suggest that DBS of the subcallosal cingulate is safe and associated with improvements in mood and anxiety. Here, we investigated the safety, clinical, and neuroimaging outcomes of DBS of the subcallosal cingulate in a group of patients during 12 months of active stimulation.

Deep brain stimulation of the subcallosal cingulate for treatment-refractory anorexia nervosa: 1 year follow-up of an open-label trial.

Ethical surgical placebo-controlled trials of deep brain stimulation for treatment-resistant anorexia nervosa - Authors' reply.

MRI guided focused ultrasound is an emerging technique that uses acoustic energy to noninvasively treat intracranial disorders. At high frequencies, it can be used to raise tissue temperatures and ablate discrete brain targets with sub-millimeter accuracy. This application is currently under investigation for a broad range of clinical applications, including brain tumors, movement disorders, and psychiatric conditions. At low frequencies MRI guided focused ultrasound can be used to modulate neuronal activity and in conjunction with injected microbubbles, can open the blood-brain barrier to enhance the delivery of therapeutic compounds. The last decade has seen dramatic advances in the science of MRI guided focused ultrasound, helping elucidate both its mechanisms and potential in pre-clinical models, and its translational promise across myriad clinical applications. This review provides an update of current and emerging MRI guided focused ultrasound applications for intracranial disorders and describes future directions and challenges for the field.

Article	Year
A review of ablative techniques in the treatment of breast fibroadenomata. Journal of therapeutic ultrasound\| PubMed ID: 26788322	2016
A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. The New England journal of medicine\| PubMed ID: 27557301	2016
"The Actualized Neurosurgeon": A Proposed Model of Surgical Resident Development. World neurosurgery\| PubMed ID: 28012887	2017
Deep brain stimulation of the subcallosal cingulate for treatment-refractory anorexia nervosa: 1 year follow-up of an open-label trial. The lancet. Psychiatry\| PubMed ID: 28238701	2017
Ethical surgical placebo-controlled trials of deep brain stimulation for treatment-resistant anorexia nervosa - Authors' reply. The lancet. Psychiatry\| PubMed ID: 28554428	2017
Current and emerging brain applications of MR-guided focused ultrasound. Journal of therapeutic ultrasound\| PubMed ID: 29034095	2017

Nir Lipsman

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