This week I observed more MR guided focused ultrasound ablation cases, as well as two more surgical procedures. The focused ultrasound cases are so exciting every time - they are able to precisely ablate a 3mm sphere of brain tissue called the Ventral Intermediate Nucleus (VIM) of the thalamus. This helps reduce/eliminate tremors permanently. This weeks cases were bilateral - meaning that it was the second MRgFUS procedure, targeting the other half of the brain (patients receive their first treatment 9-15 months prior). Symptom relief is immediate, with the only known side-effect being temporary nausea and in rare cases some numbness in fingertips/facial regions. Recurrence of tremors occurs is ~10% of patients, and is theorized to be due to an incomplete ablation of the VIM, but little is understood about what causes the recurrence. Recently, Dr. Kaplitt submitted a paper to JAMA regarding bilateral MRgFUS. Many in the field are cautious about the side effects of performing symmetrical ablation. However, Dr. Kaplitt has found that in his patients, performing the procedure bilaterally improves patient symptoms without any additional consequences to unilateral ablation.
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