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Cavitation with low-energy sonication during focused ultrasound thalamotomy for a patient with tremor-dominant Parkinson’s disease: a potential risk

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Abstract

We report a patient with tremor-dominant Parkinson’s disease who had a mild cavitation bioeffect during magnetic resonance–guided focused ultrasound thalamotomy. During the aligning phase with low-energy sonication, cavitation caused mild dysarthria and paresthesia, prompting treatment cessation. At the same time, tremor and rigidity improved. MRI revealed extensive high-intensity lesions in the thalamus 1 day after the procedure followed by steroid infusion, which resulted in resolution of adverse events. Tremor and rigidity improved 1.5 years after the procedure. Although cavitation can relieve tremors and rigidity, it should be carefully monitored due to potential permanent adverse events by unpredictable and unknown behaviors.

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Abbreviations

AC:

Anterior commissure

DRTT:

Dentato-rubro-thalamic tract

DTT:

Diffusion tensor tractography

DWI:

Diffusion-weighted image

FA:

Fractional anisotropy

FUS:

Focused ultrasound

GPi:

Globus pallidus interna

MRgFUS:

Magnetic resonance–guided focused ultrasound

MRI:

Magnetic resonance imaging

PC:

Posterior commissure

TDPD:

Tremor-dominant Parkinson’s disease

T2WI:

T2-weighted image

VIM:

Ventral intermediate nucleus

Vc:

Ventral caudal nucleus

Vo:

Ventro-oral nucleus

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Authors and Affiliations

  1. International Academia for Focused Ultrasound Therapy, Katahira, Asaoku, Kawasaki, Kanagawa, 215-0023, Japan

    Toshio Yamaguchi & Ken Iijima

  2. Research Institute of Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan

    Toshio Yamaguchi

  3. Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan

    Masayuki Nakano & Jinichi Sasanuma

  4. Department of Anesthesiology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan

    Masahito Takasaki

  5. Department of Neurology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan

    Futaba Maki, Sakae Hino & Mayumi Kaburagi

  6. Department of Neurosurgery, Juntendo University, Bunkyo City, Tokyo, Japan

    Hirokazu Iwamuro

  7. Southern Tohoku Research Institute for Neuroscience, Koriyama, Fukushima, Japan

    Kazuo Watanabe

Authors
  1. Toshio Yamaguchi
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  2. Masayuki Nakano
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  3. Jinichi Sasanuma
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  4. Masahito Takasaki
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  5. Futaba Maki
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  6. Sakae Hino
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  7. Mayumi Kaburagi
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  8. Ken Iijima
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  9. Hirokazu Iwamuro
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  10. Kazuo Watanabe
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Toshio Yamaguchi, Masayuki Nakano, Jinichi Sasanuma, Masahito Takasaki, Futaba Maki, Sakae Hino, Mayumi Kaburagi, Ken Iijima, Hirokazu Iwamuro, and Kazuo Watanabe. The first draft of the manuscript was written by Toshio Yamaguchi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Toshio Yamaguchi.

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Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The patient has consented to the submission of the case report for submission to the journal.

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The authors declare no competing interests.

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Yamaguchi, T., Nakano, M., Sasanuma, J. et al. Cavitation with low-energy sonication during focused ultrasound thalamotomy for a patient with tremor-dominant Parkinson’s disease: a potential risk. Acta Neurochir 165, 1195–1200 (2023). https://doi.org/10.1007/s00701-023-05551-4

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  • DOI: https://doi.org/10.1007/s00701-023-05551-4

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