Successful MRI-Guided Focused Ultrasound Thalamotomy after Ipsilateral Gamma Knife Radiosurgery for Essential Tremor : A Case Report with Video

Article Article scientifique Rapport de cas Successful MRI-Guided Focused Ultrasound Thalamotomy after Ipsilateral Gamma Knife Radiosurgery for Essential Tremor : A Case Report with Video eng 2023-11-02 2023 author Fleury Vanessa Department of Neurology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland. 840771 Département des neurosciences cliniques (OTONO) author Romascano David Medical Image Processing Laboratory, Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland. author Schneider Damien Loïc Department of Neurology, Geneva University Hospital, Geneva, Switzerland. 808326 author Tuleasca Constantin Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland. author Lorton Orane Image Guided Interventions Laboratory, University of Geneva, Geneva, Switzerland.,Division of Radiology, Geneva University Hospitals, Geneva, Switzerland. 855324 author Tomkova Emilie Department of Neurology, Geneva University Hospital, Geneva, Switzerland. author Catalano Sabina Department of Neurology, Geneva University Hospital, Geneva, Switzerland. 507782 author Chytas Vasileios Department of Psychiatry, Geneva University Hospital, Geneva, Switzerland. 831620 author Luscher Christian Department of Neurology, Geneva University Hospital, Geneva, Switzerland.,Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 34378 author Burkhard Pierre 0000-0002-7459-5778 Department of Neurology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland. 92389 Décanat et administration de la faculté de médecine (ADMED) author Salomir Rares Vincent Image Guided Interventions Laboratory, University of Geneva, Geneva, Switzerland.,Division of Radiology, Geneva University Hospitals, Geneva, Switzerland. 682178 Département de radiologie et informatique médicale (RADIO) author Levivier Marc Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland. author Momjian Shahan Marc Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland. 84022 Département des neurosciences cliniques (OTONO) 380-386 10.1159/000534014 37918368 1011-6125 https://karger.com/article/doi/10.1159/000534014 We report the case of a 67-year-old left-handed female patient with disabling medically refractory essential tremor who underwent successful right-sided magnetic resonance-guided focused ultrasound (MRgFUS) of the ventral intermediate nucleus after ipsilateral gamma knife radiosurgery (GKRS) thalamotomy performed 3 years earlier. The GKRS had a partial effect on her postural tremor without side effects, but there was no reduction of her kinetic tremor or improvement in her quality of life (QoL). The patient subsequently underwent a MRgFUS thalamotomy, which induced an immediate and marked reduction in both the postural and kinetic tremor components, with minor complications (left upper lip hypesthesia, dysmetria in her left hand, and slight gait ataxia). The MRgFUS-induced lesion was centered more medially than the GKRS-induced lesion and extended more posteriorly and inferiorly. The MRgFUS-induced lesion interrupted remaining fibers of the dentatorubrothalamic tract (DRTT). The functional improvement 1-year post-MRgFUS was significant due to a marked reduction of the patient's kinetic tremor. The QoL score (Quality of Life in Essential Tremor) improved by 88% and her Clinical Rating Scale for Tremor left hand score by 62%. The side effects persisted but were minor, with no impact on her QoL. The explanation for the superior efficacy of MRgFUS compared to GKRS in our patient could be due to either a poor response to the GKRS or to a better localization of the MRgFUS lesion with a more extensive interruption of DRTT fibers. In conclusion, MRgFUS can be a valuable therapeutic option after unsatisfactory GKRS, especially because MRgFUS has immediate clinical effectiveness, allowing intra-procedural test lesions and possible readjustment of the target if necessary. Essential tremor Gamma knife radiosurgery Gamma knife radiosurgery hypo-responder MRI-guided high intensity focused ultrasound Dewey 616.8 Dewey 616.89 Dewey 616.0757 61 Département des neurosciences cliniques 226 53 Département de neurosciences fondamentales 21A 62 Département de radiologie et informatique médicale 227 60 Département de psychiatrie 225 false 124 Groupe Pierre Burkhard (neurologie) 154 926 Imagerie per-opératoire multi-modalité en radiologie interventionnelle 949 271 Mécanismes cellulaires de la dépendance et de l'addiction 520 Stereotactic and functional neurosurgery 101 6 771ef15a-2b64-4d1f-8d51-4d6b44f834b7 Article (Published version) Restricted Fleury_2023.pdf 721126 application/pdf 61d80c335490d45efb67f4d1c7390f25ded13719b916e37319e4a53578892a15 96bd5024-9020-4c80-ad44-0f193acfa356 Supplemental data Restricted Supplementary_material-Supplementar.docx 20635 application/vnd.openxmlformats-officedocument.wordprocessingml.document 49864f2670d775a5231d23bc56efe7e6c994efa4851420c79a5164705b2d1cad fc147909-7cf4-4305-acb0-0fc3f05d99c9 Supplemental data Restricted Supplementary_video-video_face_off_.mp4 34406345 video/mp4 aec68e681ed7ad1d65992400820048d529fd867ef49704122203a79c453dfe16 2fdb44c2-aa7c-469f-8e91-7d13c311ab28 Article (Accepted version) Public Fleury_2023_case_report_proof.pdf 1583108 application/pdf Restricted 2025-01-01 640021ce155e40646d2ecf7ab77f773b13052934dca64a3a64b9a8da751b0ff5 openAccess Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques Faculté de médecine / Section de médecine fondamentale / Département de neurosciences fondamentales Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale Faculté de médecine / Section de médecine clinique / Département de psychiatrie

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Successful MRI-Guided Focused Ultrasound Thalamotomy after Ipsilateral Gamma Knife Radiosurgery for Essential Tremor : A Case Report with Video	Stereotactic and functional neurosurgery			2023	16	29

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Schneider, Damien Loïc