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Naoya Hashimoto, Takehiko Sakakibara, Kazuaki Yamamoto, Masahito Fujimoto and Tarumi Yamaki

✓ The case of a chronic subdural hematoma is presented in which the computerized tomography scan showed two parallel fluid-blood density levels. The authors emphasize the importance of this finding in the management of such cases.

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Kazuaki Yamamoto, Hisashi Ito, Shigeru Fukutake, Takashi Odo, Tetsumasa Kamei, Toshio Yamaguchi and Takaomi Taira

Transcranial MR-guided focused ultrasound (MRgFUS) therapy is a less invasive form of stereotactic treatment for tremors and other movement disorders. Its stereotactic accuracy is ensured by stability of the stereotactic frame and MR table. The authors report a case wherein the patient’s movement was detected, and the MR images were repeated to continue the treatment.

A 72-year-old man with essential tremor underwent unilateral ventralis intermedius thalamotomy using MRgFUS. The stereotactic frame was correctly fixed to the patient’s skull and the table. During the seventh sonication, the patient pressed the emergency button and vomited several times. Before the eighth sonication, the patient’s movement was detected and was verified on coronal images. The MR images were repeated, and the treatment was successfully completed with significant improvement in the tremors. After treatment, it was discovered that the MR table was laterally unstable due to the absence of ball bearings, which should be present on both sides of the guide rail of the MR table. The ball bearings were attached to the reverse side of the table, and the table was stabilized. Stereotactic accuracy of MRgFUS is not only ensured by rigid fixation of the stereotactic frame, but also by stability of the MR table.