Minimally invasive treatment of intracerebral hemorrhage with magnetic resonance–guided focused ultrasound

Laboratory investigation

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  • 1 Departments of Neurological Surgery,
  • 2 Neuroradiology, and
  • 3 Neuropathology, University of Virginia Health System;
  • 4 Focused Ultrasound Surgery Foundation, Charlottesville, Virginia;
  • 5 Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer; and
  • 6 InSightec, Haifa, Israel
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Object

Intracerebral hemorrhage (ICH) is a major cause of death and disability throughout the world. Surgical techniques are limited by their invasive nature and the associated disability caused during clot removal. Preliminary data have shown promise for the feasibility of transcranial MR-guided focused ultrasound (MRgFUS) sonothrombolysis in liquefying the clotted blood in ICH and thereby facilitating minimally invasive evacuation of the clot via a twist-drill craniostomy and aspiration tube.

Methods and Results

In an in vitro model, the following optimum transcranial sonothrombolysis parameters were determined: transducer center frequency 230 kHz, power 3950 W, pulse repetition rate 1 kHz, duty cycle 10%, and sonication duration 30 seconds. Safety studies were performed in swine (n = 20). In a swine model of ICH, MRgFUS sonothrombolysis of 4 ml ICH was performed. Magnetic resonance imaging and histological examination demonstrated complete lysis of the ICH without additional brain injury, blood-brain barrier breakdown, or thermal necrosis due to sonothrombolysis. A novel cadaveric model of ICH was developed with 40-ml clots implanted into fresh cadaveric brains (n = 10). Intracerebral hemorrhages were successfully liquefied (> 95%) with transcranial MRgFUS in a highly accurate fashion, permitting minimally invasive aspiration of the lysate under MRI guidance.

Conclusions

The feasibility of transcranial MRgFUS sonothrombolysis was demonstrated in in vitro and cadaveric models of ICH. Initial in vivo safety data in a swine model of ICH suggest the process to be safe. Minimally invasive treatment of ICH with MRgFUS warrants evaluation in the setting of a clinical trial.

Abbreviations used in this paper:BBB = blood-brain barrier; ICH = intracerebral hemorrhage; ICP = intracranial pressure; IVH = intraventricular hemorrhage; MRgFUS = MR-guided focused ultrasound; tPA = tissue plasminogen activator.

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Contributor Notes

Address correspondence to: Stephen J. Monteith, M.D., Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia 22908. email: stephen.monteith@gmail.com.

Please include this information when citing this paper: published online January 18, 2013; DOI: 10.3171/2012.12.JNS121095.

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