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David Moser, Eyal Zadicario, Gilat Schiff, and Daniel Jeanmonod

T he therapeutic application of focused ultrasound in functional neurosurgery requires refined target reconstructions and precise targeting accuracy measurements within the millimeter domain. Because targets are in normal tissue, coordinates have to be established for each target on the basis of a stereotactic atlas of the human brain. Such an atlas uses internal landmarks to position a coordinate system onto the brain, allowing the placement of any desired target inside the brain. We use the Stereotactic Atlas of the Human Thalamus and Basal Ganglia , 1

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Marc N. Gallay, David Moser, and Daniel Jeanmonod

T he first clinical study with incisionless transcranial MR-guided high-intensity focused ultrasound in the field of functional neurosurgery was published by Martin et al. in 2009. Since publication of this first trial, around 200 treatments have been reported. As each reported series has small numbers, 8 , 11 , 12 , 14 , 19 , 20 , 24 , 26 , 28 , 40 , 41 , 44 no procedure-related risk profile can be reliably inferred yet. To assess risks, one also needs an analysis of targeting accuracy, which is directly related to the risk of damage to neighboring structures

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Marc N. Gallay, David Moser, and Daniel Jeanmonod

T he first clinical study with incisionless transcranial MR-guided high-intensity focused ultrasound in the field of functional neurosurgery was published by Martin et al. in 2009. Since publication of this first trial, around 200 treatments have been reported. As each reported series has small numbers, 8 , 11 , 12 , 14 , 19 , 20 , 24 , 26 , 28 , 40 , 41 , 44 no procedure-related risk profile can be reliably inferred yet. To assess risks, one also needs an analysis of targeting accuracy, which is directly related to the risk of damage to neighboring structures

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Marc N. Gallay, David Moser, and Daniel Jeanmonod

incisionless transcranial MR-guided focused ultrasound functional neurosurgery: single-center experience with 253 targets in 180 treatments . J Neurosurg 130 : 1234 – 1243 , 2019 20 Gallay MN , Moser D , Rossi F , Pourtehrani P , Magara AE , Kowalski M , : Incisionless transcranial MR-guided focused ultrasound in essential tremor: cerebellothalamic tractotomy . J Ther Ultrasound 4 : 5 , 2016 21 Hassler R : Architectonic organization of the thalamic nuclei , in Schaltenbrand G , Walker AE (eds): Stereotaxy of the Human Brain. Anatomical

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Marc Gallay and Daniel Jeanmonod

, Nanda A : A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor . Neurosurg Focus 44 ( 2 ): E4 , 2018 10.3171/2017.11.FOCUS17628 29385917 11 Molina-Negro P : Functional surgery of abnormal movements , in Rasmussen TT , Marina R (eds): Functional Neurosurgery . New York : Raven Press , 1979 , pp 89 – 121 12 Plaha P , Javed S , Agombar D , O’Farrell G , Khan S , Whone A , : Bilateral caudal zona incerta nucleus stimulation for essential tremor: outcome

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Daniel Jeanmonod, Beat Werner, Anne Morel, Lars Michels, Eyal Zadicario, Gilat Schiff, and Ernst Martin

landmark clinical study 23 examined the feasibility and initial technical results of tcMRgFUS and showed for the first time in 3 patients that it is possible to focus the ultrasound beam through the intact skull into the brain and to visualize internal heating at the focal point and on the brain surface by using MR imaging temperature mapping. These findings constitute a significant step forward in establishing an entirely noninvasive alternative therapy to surgery for brain disorders. Based on our long-term clinical experience in functional neurosurgery for