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Impact of skull density ratio on efficacy and safety of magnetic resonance-guided focused ultrasound treatment of essential tremor

 Marissa D'Souza  ;  Kevin S Chen  ;  Jarrett Rosenberg  ;  W Jeffrey Elias  ;  Howard M Eisenberg  ;  Ryder Gwinn  ;  Takaomi Taira  ;  Jin Woo Chang  ;  Nir Lipsman  ;  Vibhor Krishna  ;  Keiji Igase  ;  Kazumichi Yamada  ;  Haruhiko Kishima  ;  Rees Cosgrove  ;  Jordi Rumià  ;  Michael G Kaplitt  ;  Hidehiro Hirabayashi  ;  Dipankar Nandi  ;  Jaimie M Henderson  ;  Kim Butts Pauly  ;  Mor Dayan  ;  Casey H Halpern  ;  Pejman Ghanouni 
 JOURNAL OF NEUROSURGERY, Vol.132(5) : 1392-1397, 2020-04 
Journal Title
Issue Date
ET ; MRgFUS ; SDR ; functional neurosurgery ; magnetic resonance-guided focused ultrasound ; skull density ratio
Objective: Skull density ratio (SDR) assesses the transparency of the skull to ultrasound. Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy in essential tremor (ET) patients with a lower SDR may be less effective, and the risk for complications may be increased. To address these questions, the authors analyzed clinical outcomes of MRgFUS thalamotomy based on SDRs.

Methods: In 189 patients, 3 outcomes were correlated with SDRs. Efficacy was based on improvement in Clinical Rating Scale for Tremor (CRST) scores 1 year after MRgFUS. Procedural efficiency was determined by the ease of achieving a peak voxel temperature of 54°C. Safety was based on the rate of the most severe procedure-related adverse event. SDRs were categorized at thresholds of 0.45 and 0.40, selected based on published criteria.

Results: Of 189 patients, 53 (28%) had an SDR < 0.45 and 20 (11%) had an SDR < 0.40. There was no significant difference in improvement in CRST scores between those with an SDR ≥ 0.45 (58% ± 24%), 0.40 ≤ SDR < 0.45 (i.e., SDR ≥ 0.40 but < 0.45) (63% ± 27%), and SDR < 0.40 (49% ± 28%; p = 0.0744). Target temperature was achieved more often in those with an SDR ≥ 0.45 (p < 0.001). Rates of adverse events were lower in the groups with an SDR < 0.45 (p = 0.013), with no severe adverse events in these groups.

Conclusions: MRgFUS treatment of ET can be effectively and safely performed in patients with an SDR < 0.45 and an SDR < 0.40, although the procedure is more efficient when SDR ≥ 0.45.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Sung Woo(강성우)
Park, Mincheol(박민철)
Baik, Kyoungwon(백경원) ORCID logo https://orcid.org/0000-0001-7215-375X
Sohn, Young Ho(손영호) ORCID logo https://orcid.org/0000-0001-6533-2610
Ye, Byoung Seok(예병석) ORCID logo https://orcid.org/0000-0003-0187-8440
Lee, Phil Hyu(이필휴) ORCID logo https://orcid.org/0000-0001-9931-8462
Chang, Jin Woo(장진우) ORCID logo https://orcid.org/0000-0002-2717-0101
Jung, Jin Ho(정진호)
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