背景:磁共振引导高强度聚焦超声(MRgHiFUS)已发展成为功能性神经外科手术的可行消融治疗选择。然而,目前还不清楚,这项新技术应如何整合到当前和既定的临床实践中,并应就推荐的适应症达成共识,立体定向目标,患者选择,和结果测量。目的:总结和统一瑞士神经和神经外科界关于MRgHiFUS干预脑部疾病的现有知识和临床经验,并将其作为国家共识论文发表。方法:在瑞士从事运动障碍领域的18位经验丰富的神经外科医生和神经科医师,以及代表12个瑞士临床中心和5个医学学会的15个部门的一名健康物理学家参加了研讨会,并为共识文件做出了贡献。所有专家都有当前治疗方式或MRgHiFUS的经验。他们应邀参加了两次讲习班和共识会议以及一次在线会议。作为研讨会准备的一部分,进行了全面的文献综述,并在参与者之间分发了相关讨论主题列表。特别强调了当前的经验和实践,以及有关MRgHiFUS在功能性神经外科中的临床应用的争议领域。结果:建议解决了一般脑疾病治疗的损伤,关于MRgHiFUS适应症,立体定向目标,治疗替代方案,患者选择和管理,报告和后续行动的标准化,并初始化运动障碍介入治疗的国家注册。目前,良好的临床证据仅适用于单侧丘脑损伤治疗原发性震颤或震颤为主的帕金森病,在很小的程度上,用于帕金森病运动特征的单侧丘脑下切开术。然而,工作组明确建议进一步探索和调整以MRgHiFUS为基础的功能性损伤干预措施,并确认有必要在统一注册的基础上对这些方法进行基于结局的评估.MRgHiFUS和DBS应由熟悉这两种方法的专家进行评估。因为它们是相辅相成的治疗选择,以其独特的优势和潜力而受到赞赏。结论:这篇多学科共识论文是瑞士功能性神经外科MRgHiFUS治疗安全实施和标准化实践的代表性建议。
Background: Magnetic resonance-guided high-intensity focused ultrasound (MRgHiFUS) has evolved into a viable ablative treatment option for functional neurosurgery. However, it is not clear yet, how this new technology should be integrated into current and established clinical practice and a
consensus should be found about recommended indications, stereotactic targets, patient selection, and outcome measurements. Objective: To sum up and unify current knowledge and clinical experience of Swiss neurological and neurosurgical communities regarding MRgHiFUS interventions for brain disorders to be published as a national consensus paper. Methods: Eighteen experienced neurosurgeons and neurologists practicing in Switzerland in the field of movement disorders and one health physicist representing 15 departments of 12 Swiss clinical centers and 5 medical societies participated in the workshop and contributed to the consensus paper. All experts have experience with current treatment modalities or with MRgHiFUS. They were invited to participate in two workshops and
consensus meetings and one online meeting. As part of workshop preparations, a thorough literature review was undertaken and distributed among participants together with a list of relevant discussion topics. Special emphasis was put on current experience and practice, and areas of controversy regarding clinical application of MRgHiFUS for functional neurosurgery. Results: The recommendations addressed lesioning for treatment of brain disorders in general, and with respect to MRgHiFUS indications, stereotactic targets, treatment alternatives, patient selection and management, standardization of reporting and follow-up, and initialization of a national registry for interventional therapies of movement disorders. Good clinical evidence is presently only available for unilateral thalamic lesioning in treating essential tremor or tremor-dominant
Parkinson\'s disease and, to a minor extent, for unilateral subthalamotomy for
Parkinson\'s disease motor features. However, the workgroup unequivocally recommends further exploration and adaptation of MRgHiFUS-based functional lesioning interventions and confirms the need for outcome-based evaluation of these approaches based on a unified registry. MRgHiFUS and DBS should be evaluated by experts familiar with both methods, as they are mutually complementing therapy options to be appreciated for their distinct advantages and potential. Conclusion: This multidisciplinary
consensus paper is a representative current recommendation for safe implementation and standardized practice of MRgHiFUS treatments for functional neurosurgery in Switzerland.