Name: mri-guided focused ultrasound thalamotomy for patients with medically-refractory essential tremor
Uploaded: 2017-12-13T13:00:00
Description: Watch this Scientific Journal Video about MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor at JoVE.com

我们没有资金来源的这篇文章承认。

所有人类实验都是由新宁健康科学中心的机构研究伦理委员会批准的。
1. 病人识别
<ol>
	<li>与患者或替代决策者进行知情同意。向患者解释与手术相关的潜在不良事件, 如出血和神经功能缺损。</li>
	<li>评估候选患者的 MRgFUS 丘脑。在运动障碍方面有专长的医生应该进行评估。 注意: 重要的是排除鉴别诊断, 如性震颤, 帕金森氏症, 和心理震颤。此外, 神经学家应评估是否已?...

<ol>
	<li>Louis, E. D., Ottman, R., Hauser, W. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+common+is+the+most+common+adult+movement+disorder?+Estimates+of+the+prevalence+of+essential+tremor+throughout+the+world.">How common is the most common adult movement disorder? Estimates of the prevalence of essential tremor throughout the world.</a> Mov Disord. 13, 5-10 (1998).</li><li>Louis, E. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+essential+tremor:+are+there+issues+we+are+overlooking?.">Treatment of essential tremor: are there issues we are overlooking?.</a> Front Neurol. 2, 91 (2011).</li><li>Zesiewicz, T. A., Encarnacion, E., Hauser, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+essential+tremor.">Management of essential tremor.</a> Curr Neurol Neurosci Rep. 2 (4), 324-330 (2002).</li><li>Yu, H., Neimat, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+treatment+of+movement+disorders+by+deep+brain+stimulation.">The treatment of movement disorders by deep brain stimulation.</a> Neurotherapeutics. 5 (1), 26-36 (2008).</li><li>Niranjan, A., Raju, S. S., Kooshkabadi, A., Monaco, E., Flickinger, J. C., Lunsford, L. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereotactic+radiosurgery+for+essential+tremor:+Retrospective+analysis+of+a+19-year+experience.">Stereotactic radiosurgery for essential tremor: Retrospective analysis of a 19-year experience.</a> Movement Disorders: Mov Disord. , (2017).</li><li>Lipsman, N., Schwartz, M. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=MR-guided+focused+ultrasound+thalamotomy+for+essential+tremor:+a+proof-of-concept+study.">MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study.</a> The Lancet. Neurology. 12 (5), 462-468 (2013).</li><li>Elias, W. J., Lipsman, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Randomized+Trial+of+Focused+Ultrasound+Thalamotomy+for+Essential+Tremor.">A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor.</a> N Engl J Med. 375 (8), 730-739 (2016).</li><li>Hynynen, K., Jolesz, F. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Demonstration+of+potential+noninvasive+ultrasound+brain+therapy+through+an+intact+skull.">Demonstration of potential noninvasive ultrasound brain therapy through an intact skull.</a> Ultrasound Med Biol. 24 (2), 275-283 (1998).</li><li>Hamani, C., Lozano, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hardware-related+complications+of+deep+brain+stimulation:+a+review+of+the+published+literature.">Hardware-related complications of deep brain stimulation: a review of the published literature.</a> Stereotact Funct Neurosurg. 84, 248-251 (2006).</li><li>Lim, S. Y., Hodaie, M., Fallis, M., Poon, Y. Y., Mazzella, F., Moro, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gamma+knife+thalamotomy+for+disabling+tremor:+a+blinded+evaluation.">Gamma knife thalamotomy for disabling tremor: a blinded evaluation.</a> Arch Neurol. 67, 584-588 (2010).</li><li>King, N. K. K., Krishna, V., Basha, D., Elias, G., Sammartino, F., Hodaie, M., Lozano, A. M., Hutchison, W. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microelectrode+recording+findings+within+the+tractography-defined+ventral+intermediate+nucleus.">Microelectrode recording findings within the tractography-defined ventral intermediate nucleus.</a> J Neurosurg. 126, 1669-1675 (2017).</li></ol>

MRgFUS 在高强度能非造成颅内病变。目前高强度 MRgFUS 与连续波模式的650赫已优化的热消融深脑结构, 如 Vim 丘脑。MRgFUS 的使用与现有的技术, 如 DBS, 伽玛刀放射外科手术, 或射频消融治疗难治性 ET。DBS 是一个开放的手术程序, 可以与潜在的设备相关的并发症, 包括硬件故障, 破损, 和电池损耗。射频消融也是一个开放的过程, 并与脑电极的跨皮质通路有关。虽然伽玛刀是一种非侵入性的替代品, 伽玛刀...

原发性震颤 (ET) 是最常见的运动障碍, 在个人40岁或更旧的1中患病率高达4%。它的特点是姿势和意图震颤的频率约 4-7 赫兹。它通常影响上肢, 以及头部和声音, 但也可以看到在腿上。ET 可能会严重削弱, 影响日常生活的简单活动的管理能力。15-25% 的患者由于 ET 的原因被迫过早退休, 60% 的患者不申请工作或晋升, 因为无法控制的晃动2。尽管一线医疗疗法的有效性, 如心得安或扑3, 很大比例的病人不能容忍或不耐医疗治疗。在尝试了至少两种药物后仍然有症状和严重残疾的病人, 或者是那些产生难以忍受的副作用的患者, 被认为是药物难治的。
医学上难治性 ET 的病例符合手术治疗的条件。靶向丘脑的鮈中间 (Vim) 核, 一个关键的小脑-马达中继结构, 与深脑刺激 (DBS)4电极或射频消融可以帮助缓解震颤5,6。然而, 两者都是开放式神经外科手术, 潜在的并发症, 包括感染和出血。DBS 还包括长期植入的颅内电极和电池超过胸大肌。此外, 病人需要麻醉剂, 在 DBS 的情况下, 一般的麻醉剂, 以及医院的停留范围从一天到几天不等。
MR 引导下聚焦超声 (MRgFUS) 是一种新兴的无创技术治疗各种神经和精神疾病。该装置由一个头盔, 其聚焦超过1000超声光束从独立的传感器通过完整的头骨。高强度的 MRgFUS 能在靶处产生热, 导致凝血坏死。multi-centered 丘脑的随机假对照试验显示, 47% 的震颤评分在12月7时持续改善。这一结果导致了对 MRgFUS 的监管批准作为一种治疗方式和随后增加 MRgFUS 的临床医生的医疗的震颤管理。该协议详细介绍了患者的选择、准备和超声的步骤, 以及患者随访的重要因素。

<table>
	<tbody>
		<tr>
			<td>InSightec ExAblate Neuro system</td>
			<td>InSightec</td>
			<td></td>
			<td>The ExAblate Neuro consists of a helmet transducer with 1,024 independent elements, each with central frequency 650 kHz and is integrated with a 3 Tesla MR scanner.</td>
		</tr>
		<tr>
			<td>3 Tesla MRI scanner</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>MRI compatible Cosman-Roberts-Wells (CRW) stereotactic frame</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>20 mL of 1% lidocaine with 1:100,000 epinephrine</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>hair shaver/clipper</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>warming blanket</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>compression stockings</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

mri-guided focused ultrasound thalamotomy for patients with medically-refractory essential tremor

原发性震颤 (ET) 是成人最常见的震颤类型。et 不会导致预期寿命下降, 但与 et 相关的残疾对生活质量、情绪、功能活动和社会化有重大影响。患者患有 ET 不充分治疗一线药物可能有资格替代策略, 如深脑刺激, 射频消融, 和 MRI 引导聚焦超声 (MRgFUS)。高强度 MRgFUS 是一种新兴的治疗 ET 的方式, 它对病人的吸引力在于它是无创的, 并且与短暂的恢复时间有关, 因为病人在治疗后的一天回家。虽然 MRgFUS 中心仍然是有限的, 这将成为重要的临床医生考虑 MRgFUS 作为一种治疗替代, 特别是在病人的情况下, 开放手术是禁忌。本文概述了病人选择、设备设置、超声和后处理后续行动的步骤, 以及在执行 MRgFUS 过程时需要注意的关键步骤。

长期减少的震颤在治疗下肢是平均50% 在3月和40% 在12月。治疗成功可以立即评估后, 超声通过影像学发现的一个病灶在 Vim (图 1) 和性能的临床措施, 如手绘螺旋测试 (图 2)。此外, 术中 MR 热成像提供 real-time 反馈的目标温度。当温度达到 55-60 ° c 时, 预计会出现永久性病变。
患者应评?...

Watch this Scientific Journal Video about MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor at JoVE.com

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

高强度 MRI 引导聚焦超声是一种新兴的无创技术, 精确蚀脑组织。它已被证明是安全和有效的治疗医用难治性本质震颤。本文介绍了丘脑从病人选择到设备设置到后处理随访的协议。

MRI 引导下聚焦超声丘脑治疗难治性原发性震颤

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 ...

Research

JoVE Journal

Medicine

MRI-guided Disruption of the Blood-brain Barrier using Transcranial Focused Ultrasound in a Rat Model

MRI引导下的破坏血脑屏障在大鼠模型经颅聚焦超声

Focused ultrasound (FUS) disruption of the blood-brain barrier (BBB) is an increasingly investigated technique for circumventing the BBB1-5. The BBB is a ...

科研

医学

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

Assessment of Vascular Function in Patients With Chronic Kidney Disease

血管功能在慢性肾脏疾病的评估

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

MRI引导dmPFC-rTMS治疗作为治疗难治性抑郁症

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial ...

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

床边超声在肺水肿患者导液中的效果: 反瀑布协议

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The ...

Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury

Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury

[18f] fdg 示踪剂在重型颅脑损伤患者中的半定量评价

Patients with severe traumatic brain injury (sTBI) have difficulty knowing whether they are accurately expressing their thoughts and emotions because of ...

Real-Time Monitoring of Neurocritical Patients with Diffuse Optical Spectroscopies

使用漫反射光谱实时监测神经危重症患者

Neurophysiological monitoring is an important goal in the treatment of neurocritical patients, as it may prevent secondary damage and directly impact ...

Fertility Preservation in Patients with Severe Ovarian Dysfunction

严重卵巢功能障碍患者的生育保护

Ovarian function progressively declines during aging and in some pathophysiological conditions including karyotype abnormality, autoimmune diseases, ...

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

胸腰椎后凸畸形患者改良后椎柱切除术

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...

Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis

重症急性胰腺炎患者中药灌肠

Severe acute pancreatitis (SAP) is characterized by high mortality rates, numerous complications, and extreme difficulties in treatment. A traditional ...