Journal
OPERATIVE NEUROSURGERY
Volume 19, Issue 6, Pages 741-749Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ons/opaa240
Keywords
Focused ultrasound; Capsulotomy; Psychiatric surgery; Psychosurgery; Depression; OCD; MRgFUS
Categories
Funding
- Focused Ultrasound Foundation
- Harquail Centre for Neuromodulation
- University of Toronto -Department of Psychiatry, Academic Scholar Award
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BACKGROUND: Psychiatric surgery is an important domain of functional neurosurgery and involves deep brain stimulation (DBS) or lesional procedures performed for treatment-resistant psychiatric illness. It has recently become possible to use magnetic-guided focused ultrasound (MRgFUS) to perform bilateral capsulotomy, a lesional technique commonly carried out with surgical radiofrequency ablation or stereotactic radiosurgery. MRgFUS offers several advantages, including improved safety and real-time imaging of the lesions. OBJECTIVE: To describe the clinical and technical aspects of performing bilateral MRgFUS capsulotomy in patients with severe refractory depression and obsessive-compulsive disorder. METHODS: We describe the clinical and technical considerations of performing MRgFUS capsulotomy. Topics discussed include patient selection, headframe application, targeting, sonication strategies, and follow-up procedures. RESULTS: MRgFUS capsulotomy was performed in 16 patients without serious clinical or radiographic adverse events. CONCLUSION: MRgFUS allows for a safe, less invasive technique for performing a well-studied psychiatric surgery procedure-the anterior capsulotomy.
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