• Georgios A Maragkos, Jacob Kosyakovsky, Patricia Zhao, Kathryn N Kearns, Shelly Rush-Evans, Shayan Moosa, and W Jeffrey Elias.
• Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA.
• Neurosurgery. 2023 Oct 1; 93 (4): 884891884-891.

BackgroundMagnetic resonance-guided focused ultrasound (MRgFUS) has emerged as a precise, incisionless approach to cerebral lesioning and an alternative to neuromodulation in movement disorders. Despite rigorous clinical trials, long-term patient-centered outcome data after MRgFUS for tremor-predominant Parkinson's Disease (TPPD) are relatively lacking.ObjectiveTo report long-term data on patient satisfaction and quality of life after MRgFUS thalamotomy for TPPD.MethodsIn a retrospective study of patients who underwent MRgFUS thalamotomy for TPPD at our institution between 2015 and 2022, a patient survey was administered to collect self-reported measures of tremor improvement, recurrence, Patients' Global Impression of Change (PGIC), and side effects. Patient demographics, FUS parameters, and lesion characteristics were analyzed.ResultsA total of 29 patients were included with a median follow-up of 16 months. Immediate tremor improvement was achieved in 96% of patients. Sustained improvement was achieved in 63% of patients at last follow-up. Complete tremor recurrence to baseline occurred for 17% of patients. Life quality improvement denoted by a PGIC of 1 to 2 was reported by 69% of patients. Long-term side effects were reported by 38% of patients and were mostly mild. Performing a secondary anteromedial lesion to target the ventralis oralis anterior/posterior nucleus was associated with higher rates of speech-related side effects (56% vs 12%), without significant improvement in tremor outcomes.ConclusionPatient satisfaction with FUS thalamotomy for tremor-predominant PD was very high, even at longer term. Extended lesioning to target the motor thalamus did not improve tremor control and may contribute to greater frequency of postoperative motor- and speech-related side effects.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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