Repeat magnetic resonance imaging–guided focused ultrasound thalamotomy for recurrent essential tremor: case report and review of MRI findings

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An 86-year-old right-handed man with medically refractory essential tremor was treated using left-sided MRI-guided focused ultrasound (MRgFUS) thalamotomy targeting the dentatorubrothalamic tract (DRTT) at its intersection with the ventral intermediate nucleus of the thalamus, with immediate symptomatic improvement and immediate postprocedure imaging demonstrating disruption of the DRTT. The patient experienced a partial return of symptoms 9 weeks following the procedure, and MRI demonstrated retraction of the left thalamic ablation site. The patient underwent repeat left-sided MRgFUS thalamotomy 4 months after initial treatment, resulting in reduced tremor. MR thermometry temperature measurements during the second MRgFUS procedure were unreliable with large fluctuations and false readings, likely due to susceptibility effects from the initial MRgFUS procedure. Final sonications were therefore monitored using the amount of energy delivered. The patient fared well after the second procedure and had sustained improvement in tremor control at the 12-month follow-up. This is the first report to describe the technical challenges of repeat MRgFUS with serial imaging.

ABBREVIATIONS DRTT = dentatorubrothalamic tract; DTI = diffusion tensor imaging; ET = essential tremor; MRgFUS = MRI-guided focused ultrasound; Vim = ventral intermediate nucleus.
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Contributor Notes

Correspondence J. Levi Chazen: Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY. jlc2008@med.cornell.edu.INCLUDE WHEN CITING Published online January 25, 2019; DOI: 10.3171/2018.10.JNS181721.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Bond AEElias WJ: Predicting lesion size during focused ultrasound thalamotomy: a review of 63 lesions over 3 clinical trials. Neurosurg Focus 44(2):E52018

    • Search Google Scholar
    • Export Citation
  • 2

    Chang JWPark CKLipsman NSchwartz MLGhanouni PHenderson JM: A prospective trial of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor: results at the 2-year follow-up. Ann Neurol 83:1071142018

    • Search Google Scholar
    • Export Citation
  • 3

    Chazen JLSarva HStieg PEMin RJBallon DJPryor KO: Clinical improvement associated with targeted interruption of the cerebellothalamic tract following MR-guided focused ultrasound for essential tremor. J Neurosurg 129:3153232018

    • Search Google Scholar
    • Export Citation
  • 4

    Coenen VAAllert NMädler B: A role of diffusion tensor imaging fiber tracking in deep brain stimulation surgery: DBS of the dentato-rubro-thalamic tract (drt) for the treatment of therapy-refractory tremor. Acta Neurochir (Wien) 153:157915852011

    • Search Google Scholar
    • Export Citation
  • 5

    Deuschl GRaethjen JHellriegel HElble R: Treatment of patients with essential tremor. Lancet Neurol 10:1481612011

  • 6

    Elias WJHuss DVoss TLoomba JKhaled MZadicario E: A pilot study of focused ultrasound thalamotomy for essential tremor. N Engl J Med 369:6406482013

    • Search Google Scholar
    • Export Citation
  • 7

    Elias WJLipsman NOndo WGGhanouni PKim YGLee W: A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 375:7307392016

    • Search Google Scholar
    • Export Citation
  • 8

    Fasano ADe Vloo PLlinas MHlasny EKucharczyk WHamani C: Magnetic resonance imaging–guided focused ultrasound thalamotomy in Parkinson tremor: reoperation after benefit decay. Mov Disord 33:8488492018

    • Search Google Scholar
    • Export Citation
  • 9

    Fishman PS: Thalamotomy for essential tremor: FDA approval brings brain treatment with FUS to the clinic. J Ther Ultrasound 5:192017

  • 10

    Gianfelice DKhiat ABoulanger YAmara MBelblidia A: Feasibility of magnetic resonance imaging-guided focused ultrasound surgery as an adjunct to tamoxifen therapy in high-risk surgical patients with breast carcinoma. J Vasc Interv Radiol 14:127512822003

    • Search Google Scholar
    • Export Citation
  • 11

    Gorny KRBorah BJWeaver ALBrown DWoodrum DAStewart EA: Clinical predictors of successful magnetic resonance-guided focused ultrasound (MRgFUS) for uterine leiomyoma. J Ther Ultrasound 1:152013

    • Search Google Scholar
    • Export Citation
  • 12

    Hamani CLozano AM: Hardware-related complications of deep brain stimulation: a review of the published literature. Stereotact Funct Neurosurg 84:2482512006

    • Search Google Scholar
    • Export Citation
  • 13

    Harary MEssayed WIValdes PAMcDannold NCosgrove GR: Volumetric analysis of magnetic resonance-guided focused ultrasound thalamotomy lesions. Neurosurg Focus 44(2):E62018

    • Search Google Scholar
    • Export Citation
  • 14

    Khanna NGandhi DSteven AFrenkel VMelhem ER: Intracranial applications of MR imaging-guided focused ultrasound. AJNR Am J Neuroradiol 38:4264312017

    • Search Google Scholar
    • Export Citation
  • 15

    Kooshkabadi ALunsford LDTonetti DFlickinger JCKondziolka D: Gamma Knife thalamotomy for tremor in the magnetic resonance imaging era. J Neurosurg 118:7137182013

    • Search Google Scholar
    • Export Citation
  • 16

    Louis EDMachado DG: Tremor-related quality of life: a comparison of essential tremor vs. Parkinson’s disease patients. Parkinsonism Relat Disord 21:7297352015

    • Search Google Scholar
    • Export Citation
  • 17

    Louis EDOttman R: How many people in the USA have essential tremor? Deriving a population estimate based on epidemiological data. Tremor Other Hyperkinet Mov (NY) 4:2592014

    • Search Google Scholar
    • Export Citation
  • 18

    Louis EDRios EHenchcliffe C: How are we doing with the treatment of essential tremor (ET)? Persistence of patients with ET on medication: data from 528 patients in three settings. Eur J Neurol 17:8828842010

    • Search Google Scholar
    • Export Citation
  • 19

    Schuurman PRBosch DAMerkus MPSpeelman JD: Long-term follow-up of thalamic stimulation versus thalamotomy for tremor suppression. Mov Disord 23:114611532008

    • Search Google Scholar
    • Export Citation
  • 20

    Shahzadi STasker RRLozano A: Thalamotomy for essential and cerebellar tremor. Stereotact Funct Neurosurg 65:11171995

  • 21

    Sprinkhuizen SMKonings MKvan der Bom MJViergever MABakker CJBartels LW: Temperature-induced tissue susceptibility changes lead to significant temperature errors in PRFS-based MR thermometry during thermal interventions. Magn Reson Med 64:136013722010

    • Search Google Scholar
    • Export Citation
  • 22

    Tsolaki EDownes ASpeier WElias WJPouratian N: The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor. Neuroimage Clin 17:101910272017

    • Search Google Scholar
    • Export Citation
  • 23

    Wang YWang WTang J: Ultrasound-guided high intensity focused ultrasound treatment for extra-abdominal desmoid tumours: preliminary results. Int J Hyperthermia 27:6486532011

    • Search Google Scholar
    • Export Citation
  • 24

    Wintermark MDruzgal JHuss DSKhaled MAMonteith SRaghavan P: Imaging findings in MR imaging-guided focused ultrasound treatment for patients with essential tremor. AJNR Am J Neuroradiol 35:8918962014

    • Search Google Scholar
    • Export Citation
  • 25

    Young RFLi FVermeulen SMeier R: Gamma Knife thalamotomy for treatment of essential tremor: long-term results. J Neurosurg 112:131113172010

    • Search Google Scholar
    • Export Citation
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