TRANS-CRANIAL MRI-GUIDED FOCUSED ULTRASOUND SURGERY (TCMRGFUS): PRELIMINARY ITALIAN (AND WORLD-FIRST) EXPERIENCE AT 1,5 TESLA (first 3 cases treated)

PURPOSE: We present our preliminary results achieved with the first Italian installation of a trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS) certified system for functional neurosurgery. Moreover, to our knowledge, this is the world-first tcMRgFUS system ever installed on a 1.5T MRI unit. TcMRgFUS is a promising new technology for the non-invasive treatment of neurologic disorders such as Essential Tremor (ET), tremor dominant idiopathic Parkinson's Disease (PD) and Neuropathic Pain (NP). This is a new method for focal targeting and lesioning of specific regions in the brain through intact skull by using high intensity focused ultrasound beam to achieve thermal ablation and …

Trauma cranico nello sport

MALATTIA DI ERDHEIM–CHESTER: RARE LOCALIZZAZIONI SPLANCNO- ED INTRA-CRANICHE IN PAZIENTE CON STADIO AVANZATO DI MALATTIA

SCOPO DEL LAVORO Presentiamo il caso di una donna di 63 anni con storia di pseudotumor orbitae e diagnosi tardiva di Malattia di Erdheim-Chester (MEC) con coinvolgimento multisistemico e rare localizzazioni a livello splancno- ed intracranico. MATERIALI E METODI La paziente, a causa della comparsa di astenia progressivamente ingravescente, vomito e disfagia per i solidi veniva condotta al PS dove eseguiva ECG ed esami ematochimici e veniva ricoverata con la diagnosi di disidratazione e squilibrio elettrolitico. L’esame obiettivo evidenziava pallore e disidratazione di cute e mucose, ipotrofia muscolare e proptosi bulbare bilaterale da pseudotumor orbitario infiammatorio cronico con evidenti…

MRgFUS Uterine Fibroids treatments in Sicily: Preliminary Results and comparison of a Semi-Automatic and manual contouring

Background: Traditional surgery for uterine fibroids treatments (e.g. myomectomy, hysterectomy) offers very invasive therapeutic approaches, which not always preserve reproductive potential of the woman. MRgFUS (MR guided Focused UltraSound) is a new and non-invasive technique for uterine fibroids treatment, not requiring hospitalization and recovery time [1]. On June 2011 and July 2012 the first treatments were started at HSR-Giglio Hospital in Cefalù and at University Hospital (DIBIMEF) in Palermo. An initial assessment of MRgFUS treatment was made by computing the thermally-ablated volume of uterine fibroid. This volume was evaluated considering the NPV (Non Perfused Volume) on a post-t…

Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for the Treatment of Symptomatic Uterine Fibroids

Uterine fibroids, the most common benign tumor in women of childbearing age, may cause symptoms including pelvic pain, menorrhagia, dysmenorrhea, pressure, urinary symptoms, and infertility. Various approaches are available to treat symptomatic uterine fibroids. Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) represents a recently introduced noninvasive safe and effective technique that can be performed without general anesthesia, in an outpatient setting. We review the principles of MRgFUS, describing patient selection criteria for the treatments performed at our center and we present a series of five selected patients with symptomatic uterine fibroids treated with this not y…

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida RM: esperienza preliminare a 1,5T

Da qualche anno la chirurgia mediante ultrasuoni focalizzati ad alta intensità guidati da Risonanza Magnetica (Magnetic Resonance guided Focused Ultrasound Surgery, MRgFUS) si sta diffondendo anche in Italia per la palliazione del dolore da metastasi ossee, per il trattamento di tumori ossei primitivi (benigni e non), dei fibromi e dell’adenomiosi uterina; sono già stati inoltre pubblicati i risultati preliminari del trattamento di alcuni tumori epatici, pancreatici, prostatici e della mammella mediante MRgFUS. Questa innovativa tecnica prevede l’utilizzo di un’apparecchiatura di Risonanza Magnetica per il monitoraggio della procedura e sfrutta le caratteristiche fisico- meccaniche degli …

Introducing 1,5 T MRgFUS

MRgFUS is a new noninvasive thermal ablation method, consisting of a high focused ultrasound beam and a MR scanner for imaging and real-time thermal mapping. For decades, therapeutic transcranial ultrasound (tcMRgFUS) was assumed impossible. Novel technology using high-power phased array transducers and multiple channel driving electronics enabled a sharp focal point in the planned target through the intact skull allowing the use of this innovative technology for functional neurosurgery. Preliminary results have been published with systems operating with 3T MR units on patients with neurologic disorders such as essential tremor, tremor dominant idiopathic Parkinson's disease and neuropathic…

Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) for uterine fibroids: our experience on patients’ eligibility

Learning objectives Background Findings and procedure details Conclusion Personal information References

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida rm: esperienza preliminare a 1,5T (primi 2 casi trattati)

Scopo del Lavoro Presentiamo i risultati preliminari ottenuti con la prima istallazione italiana di un’apparecchiatura per la neurochirurgia funzionale mediante ultrasuoni focalizzati ad alta intensità su guida RM (trans-cranial MRI-guided Focused Ultrasound Surgery, tcMRgFUS); si tratta tra l’altro della prima apparecchiatura tcMRgFUS al mondo mai installata su uno scanner RM da 1,5T. Tale apparecchiatura è attualmente certificata (CE ed FDA) per trattamenti di neurochirurgia funzionale in pazienti con tremore essenziale (Essential Tremor, ET), Parkinson idiopatico (Parkinson Disease, PD) unilaterale prevalentemente tremorigeno e dolore neuropatico (Neuropathic Pain, NP). Materiali e Metod…

CHIRURGIA NON INVASIVA AD ULTRASUONI FOCALIZZATI RM GUIDATI (MRGFUS) PER IL TRATTAMENTO DEI FIBROMI UTERINI SINTOMATICI: NOSTRA ESPERIENZA SULL'ELEGGIBILITÀ DELLE PAZIENTI

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida RM (trans-cranial MRI-guided Focused Ultrasound Surgery, tcMRgFUS): esperienza preliminare a 1,5T

Scopo del Lavoro Presentiamo i risultati preliminari ottenuti con la prima istallazione italiana di un’apparecchiatura tcMRgFUS (prima ed unica apparecchiatura al mondo installata su uno scanner RM da 1,5T) per trattamenti di neurochirurgia funzionale in pazienti con tremore essenziale, Parkinson idiopatico unilaterale prevalentemente tremorigeno e dolore neuropatico. Materiali e Metodi Sono stati arruolati pazienti con disordini neurologici resistenti a terapia medica. I pazienti eleggibili sono stati sottoposti ad esame TC ed RM di screening per escludere controindicazioni al trattamento. I trattamenti tcMRgFUS sono stati eseguiti da un gruppo multidisciplinare ottimizzando i parametri di…

Trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS): preliminary Italian (and world-first) experience at 1,5 Tesla (first 5 patient treated)

Malignancy course of pituitary adenoma in MEN1 syndrome: Clinical-Neuroradiological signs

Pituitary carcinomas (PCa) are extremely rare, indistinguishable from pituitary adenomas on histopathological grounds and have a poor prognosis. Most PCa start as PRL or ACTH secreting tumors in males, with relapsing invasive behaviour, refractoriness to medical and radiotherapy and increasing hormonal levels. The presence of distant metastases is still required for the diagnosis of PCa. The association with genetic endocrine diseases must be taken into account, since it adds further risk of evolution towards malignancy. Intradural spinal metastases have also been reported, so a complete craniospinal MR evaluation is recommended, when clinically indicated. We report a case of PCa, associate…

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 me…

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida RM: esperienza preliminare a 1,5T (prima paziente trattata)

Presentiamo i risultati preliminari ottenuti con la prima istallazione italiana di un’apparecchiatura per la neurochirurgia funzionale mediante ultrasuoni focalizzati ad alta intensità su guida RM (trans-cranial MRI-guided Focused Ultrasound Surgery, tcMRgFUS); si tratta tra l’altro della prima apparecchiatura tcMRgFUS al mondo mai installata su uno scanner RM da 1,5T. Tale apparecchiatura è destinata a trattamenti di neurochirurgia funzionale di pazienti con tremore essenziale (Essential Tremor, ET), Parkinson idiopatico (Parkinson Disease, PD) prevalentemente tremorigeno e dolore neuropatico (Neuropa- thic Pain, NP). Sanno presentati i risultati ottenuti con i primi pazienti sottoposti …

246. Analysis of signal-to-noise ratio for a 2-channels coil developed to enable transcranial Magnetic Resonance-guided Focused Ultrasound Surgery (tcMRgFUS) with 1.5 T MRI scanners

Abstract Purpose In recent years trans-cranial Magnetic Resonance-guided Focused Ultrasound Surgery (tcMRgFUS) treatments have aroused large scientific and medical interest [1] . Usually, tcMRgFUS systems are integrated with 3 T systems which allow the use of the body RF coil for both real time imaging and MR-thermometry. At University Hospital of Palermo there is the world-first installation of a tcMRgFUS system integrated with a 1.5 T scanner. Here we present the characterization in terms of signal-to-noise ratio (SNR) of a dedicated RF coils suitably developed (by InSightec) to enable tcMRgFUS treatments with 1.5 T MR units. Methods and materials The focused ultrasound equipment (ExAblat…

Imaging of Substantia Nigra in Parkinson's Disease: A Narrative Review.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder, characterized by motor and non-motor symptoms due to the degeneration of the pars compacta of the substantia nigra (SNc) with dopaminergic denervation of the striatum. Although the diagnosis of PD is principally based on a clinical assessment, great efforts have been expended over the past two decades to evaluate reliable biomarkers for PD. Among these biomarkers, magnetic resonance imaging (MRI)-based biomarkers may play a key role. Conventional MRI sequences are considered by many in the field to have low sensitivity, while advanced pulse sequences and ultra-high-field MRI techniques have brought many advantages, partic…

Hemorragic presentation of Listeria Monocytogenes rhombencephalic abscess.

Listeria monocytogenes (LM) bacterium is a cause of central nervous system (CNS) infection and the most common cause of rhombencephalitis in immunocompetent elderly. A prompt identification of this condition should be always desirable, since its clinical manifestations are often unspecific with prodromal symptoms leading to high rates of morbidity and mortality if underestimated. CNS listeriosis magnetic resonance imaging (MRI) findings are generally not specific. However, in the appropriate clinical setting, focal brainstem hyperintensity on T2-weighted pulse sequences associated with ring-enhancement pattern after i.v. contrast media injection should be suspicious of LM abscess. The diagn…