First noninvasive thermal ablation of a brain tumor with MR-guided focused ultrasound.
Authors: Coluccia D, Fandino J, Schwyzer L, O'Gorman R, Remonda L, Anon J, Martin E, Werner B
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) allows for precise thermal ablation of target tissues. While this emerging modality is increasingly used for the treatment of various types of extracranial soft tissue tumors, it has only recently been acknowledged as a modality for noninvasive neurosurgery. MRgFUS has been particularly successful for functional neurosurgery, whereas its clinical application for tumor neurosurgery has been delayed for various technical and procedural reasons. Here, we report the case of a 63-year-old patient presenting with a centrally located recurrent glioblastoma who was included in our ongoing clinical phase I study aimed at evaluating the feasibility and safety of transcranial MRgFUS for brain tumor ablation. Applying 25 high-power sonications under MR imaging guidance, partial tumor ablation could be achieved without provoking neurological deficits or other adverse effects in the patient. This proves, for the first time, the feasibility of using transcranial MR-guided focused ultrasound to safely ablate substantial volumes of brain tumor tissue.
Introduction
Purpose
Thermal ablation
Study Objective
To evaluate the feasibility and safety of transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) for brain tumor ablation.
Animal model / Human subject
Human (Homo sapiens), strain: N/A, age: 63 years, sex: not reported
Disease model
glioblastoma
MRI or image guidance method
MR imaging guidance (MRI-guided focused ultrasound, MRgFUS)
Outcomes and Safety
Summary of Outcomes
Transcranial MR‑guided focused ultrasound produced partial thermal ablation of a centrally located recurrent glioblastoma (total ablation volume 0.7 cc; ~0.04 cc per sonication) with no new neurological deficits and improved neurological condition/quality of life over 2 months. Successful parameters reported: 25 high‑power sonications using a 650 kHz transducer (individual sonications ~10–15 s with ~3–5 min cooling intervals during a ~4 h session).
Duration of biological effect
2 months
Safety-related matter
In the treated case, 25 high-power sonications produced partial tumor ablation without provoking neurological deficits or other adverse effects; the patient experienced only a mild internal sensation of warmth after prolonged sonication and was mobile immediately post-procedure. Two earlier attempts in another patient were aborted (one due to unreliable MR thermometry likely from ferromagnetic catheter contamination, and one because the patient could not tolerate the required motionless position), with no ablative sonication performed and no reported adverse outcomes from those attempts.
Brain Region
Ultrasound Parameters
Focal Characteristics
Focal depth: None; Focal length: None; Aperture size: None
Treatment frequency
single session
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