Speakers

MRgFUS for Stereotactic and Functional Neurosurgery
1110 09:45-10:00
Functional Neurosurgery & Epilepsy/304A
Our knowledge of the nervous system in health and disease has, however, increased considerably during the last fifty years. Recently, neurosurgery reveals promising new surgical strategies especially in our field of stereotactic and functional neurosurgery by deep brain stimulation, radiosurgery, a laser ablation, MR guided focused ultrasound surgery (MRgFUS), cell therapies and etc to deal with diseases of the central nervous system. Most recently, MRgFUS is evolving and offers the new hope for the treatment of many brain disorders through both ablative mechanism and non-ablative mechanisms such as drug delivery, neuromodulation and blood brain barrier (BBB) opening. And many of the ablative thermal lesioning procedures are already penetrated in our clinical practice as one of the important surgical techniques. As we already reported in the literatures, we demonstrated the beneficial effect of MRgFUS by performing incisionless minimally invasive Vim thalamotomy and pallidotomy as a treatment for essential tremor (ET) and Parkinson’s disease (PD). And, we also underwent the clinical studies for the evaluation of the role of MRgFUS in the management of psychiatric such as obsessive compulsive disorders (OCD) and depression especially for those who are refractory for the medical managements. Most recently, we were undergoing the clinical trial of the feasibility study of blood brain barrier opening (BBBO) for the treatment of glioblastoma (GBM) and Alzheimere’s disease (AD). And now we are preparing the document for the new clinical trial for drug addiction by using the neuromodulatory mechanism of MRgFUS by the support from Focused Ultrasound (FUS) foundation in USA. All MRgFUS was performed in a 3.0 T MRI (Signa, GE, USA) using the Exablate 4000 device (Insightec, Israel), which features a 30 cm diameter hemispherical 1024 elements phased array transduced operating at 680 KHz or 220 KHZ with immobilization of patient’s head by fixation in an MRI compatible stereotactic frame (Radionics, USA). In our previous clinical trials of ablative and BBBO MRgFUS, we found that MRgFUS was a safe and very effective almost non-invasive surgical method for the medically refractory functional neurological disorders. However, we also notice that there are several important issues and unsolved obstacles of MRgFUS. In this presentation, I will also demonstrate personal experiences, trouble shootings as well as laboratory works of MRgFUS.

MR guided focused ultrasound surgery for obsessive compulsive disorders
1110 10:30-10:40
Functional Neurosurgery & Epilepsy/304A
Surgery for intractable psychiatric illness has generated considerable controversy for a variety of scientific, social and philosophical reasons. However, the surgical treatment of obsessive compulsive disorders (OCD) by lesioning techniques such as cingulotomy, capsulotomy was well accepted in the clinical field throughout the world. However, the lacks of direct neuroanatomical and pathophysiological rationales for how lesions in specific limbic areas alleviate specific OCD symptoms have been consistent criticisms of lesioning procedures. Recently, because the anatomical and neurochemical substrates of brain function in health controls and disease patients are slowly being elucidated by various functional neuroimaging techniques, these criticisms are becoming less valid. Furthermore, by using new technique such as deep brain stimulation (DBS) and by making more precise targets, it enables to treat the patients without making serious complications. However, as we recognize, DBS also has many disadvantages along with procedures and etc. Currently, MR-guided focused ultrasound (MRgFUS) has been developed as a non-invasive surgical tool of generating precisely placed focal thermal lesion in the brain. The authors underwent a feasibility study of MRgFUS for the treatment of medically refractory OCD. Patients with OCD were treated by making bilateral thermal lesions in the anterior limb of the internal capsule (capsulotomy) with MRgFUS. In this presentation, I would like to demonstrate the not only therapeutic effects but also technical & practical issues of the current MRgFUS capsulotomy for medically refractory OCD.