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Aubignat M, Tir M, Ouendo M, Boussida S, Constans JM, Lefranc M. Unilateral Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy Thalamotomy for Essential Tremor. Mov Disord 2024; 39:1006-1014. [PMID: 38532534 DOI: 10.1002/mds.29790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Essential tremor (ET) affects numerous adults, impacting quality of life (QOL) and often defying pharmacological treatment. Surgical interventions like deep brain stimulation (DBS) and lesional approaches, including radiofrequency, gamma-knife radiosurgery, and magnetic resonance imaging (MRI)-guided focused ultrasound, offer solutions but are not devoid of limitations. OBJECTIVES This retrospective, single-center, single-blinded pilot study aimed to assess the safety and efficacy of unilateral MRI-guided laser interstitial thermal therapy (MRIg-LITT) thalamotomy for medically intractable ET. METHODS Nine patients with ET, unresponsive to medications and unsuitable for DBS, underwent unilateral MRIg-LITT thalamotomy. We assessed tremor severity, QOL, cognitive function, and adverse events (AE) over a 12-month period. RESULTS Tremor severity significantly improved, with a reduction of 83.37% at 12 months post-procedure. QOL scores improved by 74.60% at 12 months. Reported AEs predominantly included transient dysarthria, proprioceptive disturbances, and gait balance issues, which largely resolved within a month. At 3 months, 2 patients (22%) exhibited contralateral hemiparesis requiring physiotherapy, with 1 patient (11%) exhibiting persistent hemiparesis at 12 months. No significant cognitive impairment was detected post-procedure. CONCLUSIONS Unilateral MRIg-LITT thalamotomy yielded substantial and enduring tremor alleviation and enhanced QOL in patients with ET that is resistant to medication. The AE profile was acceptable. Our findings support the need for additional research with expanded patient cohorts and extended follow-up to corroborate these outcomes and to refine the role of MRIg-LITT as a targeted and minimally invasive approach for ET management. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mickael Aubignat
- Department of Neurology and Movement Disorders, Amiens Picardie University Hospital, Amiens, France
- Expert Center for Parkinson's Disease, Amiens Picardie University Hospital, Amiens, France
| | - Mélissa Tir
- Department of Neurology and Movement Disorders, Amiens Picardie University Hospital, Amiens, France
- Expert Center for Parkinson's Disease, Amiens Picardie University Hospital, Amiens, France
| | - Martial Ouendo
- Expert Center for Parkinson's Disease, Amiens Picardie University Hospital, Amiens, France
- Department of Anaesthesiology and Critical Care Medicine, Amiens Picardie University Hospital, Amiens, France
| | - Salem Boussida
- Department of Radiology, Amiens Picardie University Hospital, Amiens, France
| | - Jean-Marc Constans
- Department of Radiology, Amiens Picardie University Hospital, Amiens, France
- Research Unit UR-7516 (CHIMERE) Research Team for Head & Neck, Institute Faire Faces, University of Picardie Jules Verne, Amiens, France
| | - Michel Lefranc
- Expert Center for Parkinson's Disease, Amiens Picardie University Hospital, Amiens, France
- Research Unit UR-7516 (CHIMERE) Research Team for Head & Neck, Institute Faire Faces, University of Picardie Jules Verne, Amiens, France
- Department of Neurosurgery, Amiens Picardie University Hospital, Amiens, France
- Research Unit in Robotic Surgery (GRECO), University of Picardie Jules Verne, Amiens, France
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Gunderman AL, Sengupta S, Huang Z, Sigounas D, Oluigbo C, Godage IS, Cleary K, Chen Y. Towards MR-Guided Robotic Intracerebral Hemorrhage Evacuation: Aiming Device Design and ex vivo Ovine Head Trial. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2024; 6:577-588. [PMID: 38911181 PMCID: PMC11189651 DOI: 10.1109/tmrb.2024.3385794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Stereotactic neurosurgery is a well-established surgical technique for navigation and guidance during treatment of intracranial pathologies. Intracerebral hemorrhage (ICH) is an example of various neurosurgical conditions that can benefit from stereotactic neurosurgery. As a part of our ongoing work toward real-time MR-guided ICH evacuation, we aim to address an unmet clinical need for a skull-mounted frameless stereotactic aiming device that can be used with minimally invasive robotic systems for MR-guided interventions. In this paper, we present NICE-Aiming, a Neurosurgical, Interventional, Configurable device for Effective-Aiming in MR-guided robotic neurosurgical interventions. A kinematic model was developed and the system was used with a concentric tube robot (CTR) for ICH evacuation in (i) a skull phantom and (ii) in the first ever reported ex vivo CTR ICH evacuation using an ex vivo ovine head. The NICE-Aiming prototype provided a tip accuracy of 1.41±0.35 mm in free-space. In the MR-guided gel phantom experiment, the targeting accuracy was 2.07±0.42 mm and the residual hematoma volume was 12.87 mL (24.32% of the original volume). In the MR-guided ex vivo ovine head experiment, the targeting accuracy was 2.48±0.48 mm and the residual hematoma volume was 1.42 mL (25.08% of the original volume).
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Affiliation(s)
- Anthony L Gunderman
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30338 USA
| | - Saikat Sengupta
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Zhefeng Huang
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30338 USA
| | - Dimitri Sigounas
- The George Washington University School of Medicine and Health Sciences, Department of Neurosurgery, The George Washington University, Washington, DC, US
| | - Chima Oluigbo
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC 20010 USA
| | - Isuru S Godage
- Department of Engineering Technology and Industrial Distribution, Texas A&M University, College Station, TX, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC 20010 USA
| | - Yue Chen
- Biomedical Engineering Department, Georgia Institute of Technology/Emory, Atlanta 30338 USA
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Guida L, Beccaria K, Benichi S, Kossorotof M, Naggara O, Bourgeois M, Bourdeaut F, Abbou S, Dangouloff-Ros V, Boddaert N, Blauwblomme T. Laser interstitial thermal therapy is effective and safe for the treatment of brain tumors in NF1 patients after cerebral revascularization for moyamoya angiopathy: a report on two cases. Front Neurol 2023; 14:1291207. [PMID: 38145120 PMCID: PMC10748471 DOI: 10.3389/fneur.2023.1291207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background The co-occurrence of moyamoya vasculopathy and extra-optic pathway tumors is rare in neurofibromatosis type 1 (NF1), with only four cases described in the literature. Brain surgery in these patients may be challenging because of the risk of brain infarction after skin and dural incision. Given its percutaneous and minimally invasive nature, laser interstitial thermal therapy (LITT) is an ideal option for the treatment of brain tumors in these patients. Here, we report on two patients with NF1 and moyamoya syndrome (MMS) treated for a brain glioma with LITT, after cerebral revascularization. Cases The first patient, with familial NF1, underwent bilateral indirect revascularization with multiple burr holes (MBH) for symptomatic MMS. Two years later, she was diagnosed with a left temporal tumor, with evidence of radiologic progression over 10 months. The second patient, also with familial NF1, developed unilateral MMS when he was 6 years old and was treated with MBH. At the age of 15 years, MRI showed a right cingular lesion, growing on serial MRIs. Both patients underwent LITT with no perioperative complications; they are progression free at 10 and 12 months, respectively, and the tumors have decreased in volume. Discussion While the association of extra-optic neoplasm and moyamoya angiopathy is seldom reported in NF1, tumor treatment is challenging in terms of both avoiding stroke and achieving oncological control. Here, we show in 2 cases, that LITT could be a safe and effective option in these rare conditions.
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Affiliation(s)
- Lelio Guida
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université de Paris Cité, Paris, France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université de Paris Cité, Paris, France
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université de Paris Cité, Paris, France
| | - Manoelle Kossorotof
- Université de Paris Cité, Paris, France
- Department of Pediatric Neurology, Hôpital Necker Enfants Malades, Paris, France
| | - Olivier Naggara
- Université de Paris Cité, Paris, France
- Department of Radiology, GHU Sainte-Anne, Paris, France
| | - Marie Bourgeois
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
| | - Franck Bourdeaut
- Université de Paris Cité, Paris, France
- Department of Pediatric Oncology, Institut Curie, Paris, France
| | - Samuel Abbou
- Université de Paris Cité, Paris, France
- Department of Pediatric Oncology, Institut Gustave Roussy, Villejuif, France
| | - Volodia Dangouloff-Ros
- Department of Pediatric Radiology, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université Paris Cité, UMR 1163, Institut Imagine, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université Paris Cité, UMR 1163, Institut Imagine, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université de Paris Cité, Paris, France
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