Journal of neurosurgery
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Journal of neurosurgery · Jun 2020
The relevance of skull density ratio in selecting candidates for transcranial MR-guided focused ultrasound.
Transcranial MR-guided focused ultrasound (MRgFUS) is a minimally invasive treatment for movement disorders. Considerable interpatient variability in skull transmission efficiency exists with the current clinical devices, which is thought to be dependent on each patient's specific skull morphology. Lower skull density ratio (SDR) values are thought to impede acoustic energy transmission across the skull, attenuating or preventing the therapeutic benefits of MRgFUS. Patients with SDR values below 0.4 have traditionally been deemed poor candidates for MRgFUS. Although considerable anecdotal evidence has suggested that SDR is a reliable determinant of procedural and clinical success, relationships between SDR and clinical outcomes have yet to be formally investigated. Moreover, as transcranial MRgFUS is becoming an increasingly widespread procedure, knowledge of SDR distribution in the general population may enable improved preoperative counseling and preparedness. ⋯ Although lower SDR values correlated with higher energy requirements during MRgFUS thalamotomy, within the range of this study population, the SDR did not appreciably impact or provide the ability to predict the resulting clinical outcomes. Sampling of the general population suggests that age and sex have no relationship with SDR. Other variables, such as local variances in bone density, should also be carefully reviewed to build a comprehensive appraisal of a patient's suitability for MRgFUS treatment.
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Journal of neurosurgery · Jun 2020
Alternative customized instrumentation and technique for percutaneous balloon compression rhizotomy for trigeminal neuralgia.
Trigeminal neuralgia is a debilitating disease that can be treated effectively by a number of modalities. Percutaneous balloon compression rhizotomy of the gasserian ganglion is an important technique that can be offered as a primary or secondary strategy after failure of medical therapy. However, the commercial kit for this procedure was discontinued in the United States in early 2016 and therefore is not currently available. The authors describe a low-cost, effective solution for continuing to offer this procedure using equipment already available in most hospitals. ⋯ Percutaneous balloon compression rhizotomy of the gasserian ganglion is an important technique that should be readily available to patients who are not medically fit for microvascular decompression and need immediate relief of their pain. The alternative kit described here can be assembled easily using equipment that is readily available in most hospitals.