• Oper Neurosurg (Hagerstown) · Jul 2020

    Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders.

    • Benjamin Davidson, Clement Hamani, Yuexi Huang, Ryan M Jones, Ying Meng, Peter Giacobbe, and Nir Lipsman.
    • Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
    • Oper Neurosurg (Hagerstown). 2020 Jul 31.

    BackgroundPsychiatric surgery is an important domain of functional neurosurgery and involves deep brain stimulation (DBS) or lesional procedures performed for treatment-resistant psychiatric illness. It has recently become possible to use magnetic-guided focused ultrasound (MRgFUS) to perform bilateral capsulotomy, a lesional technique commonly carried out with surgical radiofrequency ablation or stereotactic radiosurgery. MRgFUS offers several advantages, including improved safety and real-time imaging of the lesions.ObjectiveTo describe the clinical and technical aspects of performing bilateral MRgFUS capsulotomy in patients with severe refractory depression and obsessive-compulsive disorder.MethodsWe describe the clinical and technical considerations of performing MRgFUS capsulotomy. Topics discussed include patient selection, headframe application, targeting, sonication strategies, and follow-up procedures.ResultsMRgFUS capsulotomy was performed in 16 patients without serious clinical or radiographic adverse events.ConclusionMRgFUS allows for a safe, less invasive technique for performing a well-studied psychiatric surgery procedure-the anterior capsulotomy.Copyright © 2020 by the Congress of Neurological Surgeons.

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