Stereotactic Radiosurgery for Movement Disorders

Frighetto, Leonardo; Bizzi, Jorge Wladimir Junqueira; Oppitz, Paulo Petry

doi:10.1007/978-3-642-11151-8_18

Cited by 6 publications

(6 citation statements)

References 49 publications

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“…Gamma Knife radiosurgery was developed as a minimally invasive technique capable of precisely generating a focal lesion in the brain, and early candidates for its application were functional disorders including cancer pain and some psychiatric illnesses. 6,12 Although Gamma Knife radiosurgery, especially in Gamma Knife thalamotomy, have achieved an efficacy similar to RF lesioning for movement disorders, there are important issues to consider, including the time interval between treatment and effect, variability of the target area reaction, and inability to predict side effects for specific patients. 4,17 Furthermore, the complication rate associated with Gamma Knife radiosurgery in patients with movement disorders has been reported to be as high as 50%, although the reported complications were not fatal.…”

Section: Development Of Treatment Technologies For Stereotactic and Fmentioning

confidence: 99%

Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull

Chang

Jung

Zadicario

et al. 2016

JNS

161

172

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S ince the time that Spiegel and colleagues introduced stereotactic devices for the treatment of humans, there have been many advances in stereotactic procedures for treating neurological diseases, including Parkinson's disease (PD), essential tremor (ET), chronic neuropathic pain, and obsessive-compulsive disorder (OCD). 21Radiofrequency (RF) thermal ablation can create lesions in deep brain structures more easily than earlier modalities such as chemical ablation using alcohol. RF was widely applied to treat movement and psychiatric disorders until deep brain stimulation surgery was introduced. 8,11,15 However, RF lesioning procedures were found to be associated with a relatively high rate of permanent complications, especially when performed in both hemispheres. 19 As an alternative to RF thermal lesioning, bilateral deep brain stimulation has been shown to have a high success rate and an acceptable risk of complications. 23Although the risks associated with current neurosurgical procedures for movement and psychiatric disorders are considered acceptable, there are many potential procedure-, hardware-, and anesthesia-related complications that must be considered by both physicians and patients. To overcome these shortcomings, a less invasive technique using ultrasonic energy was developed. Magnetic resoabbreviatioNs Emax = maximal energy required to achieve Tmax; ET = essential tremor; MRgFUS = magnetic resonance-guided focused ultrasound surgery; OCD = obsessive-compulsive disorder; PD = Parkinson's disease; RF = radiofrequency; SDR = skull density ratio; Tmax = maximum temperature. obJective Magnetic resonance-guided focused ultrasound surgery (MRgFUS) was recently introduced as treatment for movement disorders such as essential tremor and advanced Parkinson's disease (PD). Although deep brain target lesions are successfully generated in most patients, the target area temperature fails to increase in some cases. The skull is one of the greatest barriers to ultrasonic energy transmission. The authors analyzed the skull-related factors that may have prevented an increase in target area temperatures in patients who underwent MRgFUS. methods The authors retrospectively reviewed data from clinical trials that involved MRgFUS for essential tremor, idiopathic PD, and obsessive-compulsive disorder. Data from 25 patients were included. The relationships between the maximal temperature during treatment and other factors, including sex, age, skull area of the sonication field, number of elements used, skull volume of the sonication field, and skull density ratio (SDR), were determined. results Among the various factors, skull volume and SDR exhibited relationships with the maximum temperature. Skull volume was negatively correlated with maximal temperature (p = 0.023, r 2 = 0.206, y = 64.156 − 0.028x, whereas SDR was positively correlated with maximal temperature (p = 0.009, r 2 = 0.263, y = 49.643 + 11.832x). The other factors correlate with the maximal temperature, although some factors showed a tendency to correlate...

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Section: Development Of Treatment Technologies For Stereotactic and Fmentioning

confidence: 99%

Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull

Chang

Jung

Zadicario

et al. 2016

JNS

161

172

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“…Even though staging bilateral GKT procedures with a 1-year interval seems to allow sufficient time to assess benefit as well as adverse effects, long-term concerns related to radiosurgery thalamotomy include the potential dysphagia, dysarthria, speech disorders, and cognitive deficits. 2,4,10,24 Prior reports describe 2 delayed deaths attributed to bilateral GKT. One patient died following bilateral high-dose (160 Gy and 180 GY) medial thala-motomy for chronic pain.…”

Section: Rationale For Bilateral Gktmentioning

confidence: 99%

Is staged bilateral thalamic radiosurgery an option for otherwise surgically ineligible patients with medically refractory bilateral tremor?

Niranjan¹,

Raju

Monaco³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Unilateral Gamma Knife thalamotomy (GKT) is a well-established treatment for patients with medically refractory tremor who are not eligible for invasive procedures due to increased risk of compications. The purpose of this study was to evaluate whether staged bilateral GKT provides benefit with acceptable risk to patients suffering from disabling medically refractory bilateral tremor. METHODS Eleven patients underwent staged bilateral GKT during a 17-year period (1999-2016). Eight patients had essential tremor (ET), 2 had Parkinson's disease (PD)-related tremor, and 1 had multiple-sclerosis (MS)-related tremor. For the first GKT, a median maximum dose of 140 Gy was delivered to the posterior-inferior region of the nucleus ventralis intermedius (VIM) through a single isocenter with 4-mm collimators. Patients who benefitted from unilateral GKT were eligible for a contralateral GKT 1-2 years later (median 22 months). For the second GKT, a median maximum dose of 130 Gy was delivered to the opposite VIM nucleus to a single 4-mm isocenter. The Fahn-Tolosa-Marin (FTM) clinical tremor rating scale was used to score tremor, drawing, and drinking before and after each GKT. The FTM writing score was assessed only for the dominant hand before and after the first GKT. The Karnofsky Performance Status (KPS) was used to assess quality of life and activities of daily living before and after the first and second GKT. RESULTS The median time to last follow-up after the first GKT was 35 months (range 11-70 months). All patients had improvement in at least 1 FTM score after the first GKT. Three patients (27.3%) had tremor arrest and complete restoration of function (noted via FTM tremor, writing, drawing, and drinking scores equaling zero). No patient had tremor recurrence or diminished tremor relief after the first GKT. One patient experienced new temporary neurological deficit (contralateral lower-extremity hemiparesis) from the first GKT. The median time to last follow-up after the second GKT was 12 months (range 2-70 months). Nine patients had improvement in at least 1 FTM score after the second GKT. Two patients had tremor arrest and complete restoration of function. No patient experienced tremor recurrence or diminished tremor relief after the second GKT. No patient experienced new neurological or radiological adverse effect from the second GKT. Statistically significant improvements were noted in the KPS score following the first and second GKT. CONCLUSIONS Staged bilateral GKT provided effective relief for medically refractory, disabling, bilateral tremor without increased risk of neurological complications. It is an appropriate strategy for carefully selected patients with medically refractory bilateral tremor who are not eligible for deep brain stimulation.

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“…Successful treatment results were obtained in patients who are not suitable for open surgery. In the literature, there are studies reporting that intractable tremor improved over 90% in patients who underwent thalamotomy with SRS [ 12 ]. SRS has also been performed for vascular brain pathologies for a long time.…”

Section: Discussionmentioning

confidence: 99%

Secondary Parkinsonism in a Patient With a Cerebral Cavernous Hemangioma Treated With Stereotactic Radiosurgery

Aydın¹,

Aydın²,

Yuksel³

et al. 2021

Cureus

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Secondary parkinsonism is defined with some symptoms similar to idiopathic Parkinson's disease, but with different etiologies. And cerebral cavernous hemangioma is one of the rare cases. A 51-year-old, male patient was consulted with tremor, rigidity and bradykinesia on the right upper extremity. The Hoehn and Yahr Parkinson's scale was Stage І. Radiological evaluations showed a deep-seated cerebral cavernous hemangioma at the left posterior insular region. The patient received stereotactic radiosurgery (CyberKnife®, Accuray Incorporated, Sunnyvale, CA, USA). Clinical and radiological improvements revealed within follow-up, respectively. Stereotactic radiosurgery may be an alternative treatment for secondary parkinsonism by reducing the risk of re-bleeding and reducing its size.

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Stereotactic Radiosurgery for Movement Disorders

Cited by 6 publications

References 49 publications

Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull

Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull

Is staged bilateral thalamic radiosurgery an option for otherwise surgically ineligible patients with medically refractory bilateral tremor?

Secondary Parkinsonism in a Patient With a Cerebral Cavernous Hemangioma Treated With Stereotactic Radiosurgery

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