Cranial MR-Guided Focused Ultrasound: Clinical Challenges and Future Directions.

Publication Type	Review
Authors	Chazen J, Stavarache M, Kaplitt M
Journal	World Neurosurg
Volume	145
Pagination	574-580
Date Published	01/01/2021
ISSN	1878-8769
Keywords	Brain Diseases, High-Intensity Focused Ultrasound Ablation, Intraoperative Neurophysiological Monitoring, Magnetic Resonance Imaging
Abstract	Magnetic resonance-guided focused ultrasound is a powerful new technology that is enabling development of noninvasive applications for complex brain disorders. This is currently revolutionizing the treatment of tremor disorders, and a variety of experimental applications are under active investigation. To fully realize the potential of this disruptive technology, many challenges have been identified, some of which have been addressed and others remain to be solved. As an image-based technology, optimal intraoperative imaging can be difficult to achieve and several factors can influence the quality of these images. Technical issues with current devices can also limit the effective delivery of ultrasound technology to particular targets. While lesioning is the primary approved application of magnetic resonance-guided focused ultrasound at present, the ability to transient and precisely open the blood-brain barrier has the potential to clear brain pathologies and deliver restorative therapies, but this more experimental method presents unique difficulties to overcome. Finally, regulatory and reimbursement hurdles currently remain complex and continue to limit widespread application of even approved, effective applications. Here we review many of these challenges, discuss several solutions that have already been developed, and propose potential options for addressing some of these complexities in the future.
DOI	10.1016/j.wneu.2020.08.050
PubMed ID	33348523