TRANS-CRANIAL MRI-GUIDED FOCUSED ULTRASOUND SURGERY (TCMRGFUS): ITALIAN AND WORLD-FIRST EXPERIENCE AT 1.5 TESLA

Introduction: Transcranial magnetic resonance-guided focused ultrasound surgery (tcMRgFUS) is a promising new technology for the noninvasive treatment of various brain disorders. Here, we present our preliminary results achieved with the first Italian installation of a transcranial MRI-guided focused ultrasound surgery (tcMRgFUS) certified system for functional neurosurgery. Technical issues faced to achieve a safe and effective treatment will be discussed focusing on MR high-resolution live imaging and thermometry sequences optimization. Materials and Methods: Patient enrollment was based on indication for functional neurosurgery and evidence of medication-refractory disease; a detailed medical history has been collected together with a complete clinical examination and a neurophysiological assessment. Eligible patients have been screened by MDCT and MRI. Results: Although this is a preliminary experience, the clinical success of our first treatments proves that this promising new technology for non-invasive treatment of various brain disorders can be safely and effectively performed also with the most popular MRI units operating at 1.5 T. Conclusion: TcMRgFUS treatments are currently performed in a very few centers in the world and only using 3 T MRI units. This is the world-first experience of functional neurosurgery successfully performed with a tcMRgFUS installed on the most popular and affordable 1.5 T MR units. Thanks to the use of a radiation-free technique like the MRI as a guide and to the possibility of verifying the clinical effectiveness of such an innovative treatment before a permanent lesion is made in the targeted area of the brain, this technique allows for a huge step forward for both interventional neuroradiology and functional neurosurgery.