{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:44:54Z","timestamp":1784821494261,"version":"3.55.0"},"reference-count":58,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,2]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Magnetic resonance\u2013guided focused ultrasound (MRgFUS) thalamotomy was recently approved for use in the treatment of medication-refractory essential tremor (ET). Previous work has described lesion appearance and volume on MRI up to 6 months after treatment. Here, the authors report on the volumetric segmentation of the thalamotomy lesion and associated edema in the immediate postoperative period and 1 year following treatment, and relate these radiographic characteristics with clinical outcome.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Seven patients with medication-refractory ET underwent MRgFUS thalamotomy at Brigham and Women\u2019s Hospital and were monitored clinically for 1 year posttreatment. Treatment effect was measured using the Clinical Rating Scale for Tremor (CRST). MRI was performed immediately postoperatively, 24 hours posttreatment, and at 1 year. Lesion location and the volumes of the necrotic core (zone I) and surrounding edema (cytotoxic, zone II; vasogenic, zone III) were measured on thin-slice T2-weighted images using Slicer 3D software.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Patients had significant improvement in overall CRST scores (baseline 51.4 \u00b1 10.8 to 24.9 \u00b1 11.0 at 1 year, p = 0.001). The most common adverse events (AEs) in the 1-month posttreatment period were transient gait disturbance (6 patients) and paresthesia (3 patients). The center of zone I immediately posttreatment was 5.61 \u00b1 0.9 mm anterior to the posterior commissure, 14.6 \u00b1 0.8 mm lateral to midline, and 11.0 \u00b1 0.5 mm lateral to the border of the third ventricle on the anterior commissure\u2013posterior commissure plane. Zone I, II, and III volumes immediately posttreatment were 0.01 \u00b1 0.01, 0.05 \u00b1 0.02, and 0.33 \u00b1 0.21 cm\n 3<\/jats:sup>\n , respectively. These volumes increased significantly over the first 24 hours following surgery. The edema did not spread evenly, with more notable expansion in the superoinferior and lateral directions. The spread of edema inferiorly was associated with the incidence of gait disturbance. At 1 year, the remaining lesion location and size were comparable to those of zone I immediately posttreatment. Zone volumes were not associated with clinical efficacy in a statistically significant way.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n MRgFUS thalamotomy demonstrates sustained clinical efficacy at 1 year for the treatment of medication-refractory ET. This technology can create accurate, predictable, and small-volume lesions that are stable over time. Instances of AEs are transient and are associated with the pattern of perilesional edema expansion. Additional analysis of a larger MRgFUS thalamotomy cohort could provide more information to maximize clinical effect and reduce the rate of long-lasting AEs.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2017.11.focus17587","type":"journal-article","created":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T03:37:25Z","timestamp":1517456245000},"page":"E6","source":"Crossref","is-referenced-by-count":45,"title":["Volumetric analysis of magnetic resonance\u2013guided focused ultrasound thalamotomy lesions"],"prefix":"10.3171","volume":"44","author":[{"given":"Maya","family":"Harary","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid I.","family":"Essayed","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo A.","family":"Valdes","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"McDannold","sequence":"additional","affiliation":[{"name":"Radiology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Rees","family":"Cosgrove","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Ultrasound Med Biol","first-page":"409","article-title":"Effects of physical parameters on high temperature ultrasound hyperthermia","volume":"16","author":"Billard BE","year":"1990","unstructured":"Billard BE, Hynynen K, Roemer RB: Effects of physical parameters on high temperature ultrasound hyperthermia. Ultrasound Med Biol 16:409\u2013420, 1990"},{"key":"b2","series-title":"J Neurol Neurosurg Psychiatry","first-page":"257","article-title":"Unilateral magnetic resonance guided focused ultrasound thalamotomy for essential tremor: practices and clinicoradiological outcomes","volume":"86","author":"Chang WS","year":"2015","unstructured":"Chang WS, Jung HH, Kweon EJ, Zadicario E, Rachmilevitch I, Chang JW: Unilateral magnetic resonance guided focused ultrasound thalamotomy for essential tremor: practices and clinicoradiological outcomes. J Neurol Neurosurg Psychiatry 86:257\u2013264, 2015"},{"key":"b3","series-title":"World Neurosurg","first-page":"354","article-title":"Focused ultrasound: relevant history and prospects for the addition of mechanical energy to the neurosurgical armamentarium","volume":"82","author":"Christian E","year":"2014","unstructured":"Christian E, Yu C, Apuzzo ML: Focused ultrasound: relevant history and prospects for the addition of mechanical energy to the neurosurgical armamentarium. World Neurosurg 82:354\u2013365, 2014"},{"key":"b4","series-title":"Med Phys","first-page":"2017","article-title":"Thermal dosimetry of a focused ultrasound beam in vivo by magnetic resonance imaging","volume":"26","author":"Chung AH","year":"1999","unstructured":"Chung AH, Jolesz FA, Hynynen K: Thermal dosimetry of a focused ultrasound beam in vivo by magnetic resonance imaging. Med Phys 26:2017\u20132026, 1999"},{"key":"b5","series-title":"J Neurosurg","article-title":"Noninvasive neuromodulation and thalamic mapping with low-intensity focused ultrasound","author":"Dallapiazza RF","unstructured":"Dallapiazza RF, Timbie KF, Holmberg S, Gatesman J, Lopes MB, Price RJ, : Noninvasive neuromodulation and thalamic mapping with low-intensity focused ultrasound. J Neurosurg [epub ahead of print April 21, 2017. DOI: 10.3171\/2016.11.JNS16976]"},{"key":"b6","series-title":"J Acoust Soc Am","first-page":"1641","article-title":"The effect of various physical parameters on the size and shape of necrosed tissue volume during ultrasound surgery","volume":"95","author":"Damianou C","year":"1994","unstructured":"Damianou C, Hynynen K: The effect of various physical parameters on the size and shape of necrosed tissue volume during ultrasound surgery. J Acoust Soc Am 95:1641\u20131649, 1994"},{"key":"b7","series-title":"N Engl J Med","first-page":"640","article-title":"A pilot study of focused ultrasound thalamotomy for essential tremor","volume":"369","author":"Elias WJ","year":"2013","unstructured":"Elias WJ, Huss D, Voss T, Loomba J, Khaled M, Zadicario E, : A pilot study of focused ultrasound thalamotomy for essential tremor. N Engl J Med 369:640\u2013648, 2013"},{"key":"b8","series-title":"N Engl J Med","first-page":"730","article-title":"A randomized trial of focused ultrasound thalamotomy for essential tremor","volume":"375","author":"Elias WJ","year":"2016","unstructured":"Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, : A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 375:730\u2013739, 2016"},{"key":"b9","series-title":"Neuroimage Clin","first-page":"659","article-title":"White matter tractography for neurosurgical planning: a topography-based review of the current state of the art","volume":"15","author":"Essayed WI","year":"2017","unstructured":"Essayed WI, Zhang F, Unadkat P, Cosgrove GR, Golby AJ, O\u2019Donnell LJ: White matter tractography for neurosurgical planning: a topography-based review of the current state of the art. Neuroimage Clin 15:659\u2013672, 2017"},{"issue":"Suppl 14","key":"b10","series-title":"Mov Disord","first-page":"S259","article-title":"Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson\u2019s disease and tremor","volume":"21","author":"Gross RE","year":"2006","unstructured":"Gross RE, Krack P, Rodriguez-Oroz MC, Rezai AR, Benabid AL: Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson\u2019s disease and tremor. Mov Disord 21 (Suppl 14):S259\u2013S283, 2006"},{"key":"b11","series-title":"Stereotact Funct Neurosurg","first-page":"28","article-title":"Is there a relationship between size and site of the stereotactic lesion and symptomatic results of pallidotomy and thalamotomy?","volume":"69","author":"Hariz MI","year":"1997","unstructured":"Hariz MI, Hirabayashi H: Is there a relationship between size and site of the stereotactic lesion and symptomatic results of pallidotomy and thalamotomy? Stereotact Funct Neurosurg 69:28\u201345, 1997"},{"key":"b12","series-title":"Stereotact Funct Neurosurg","first-page":"307","article-title":"Impact of parameters of radiofrequency coagulation on volume of stereotactic lesion in pallidotomy and thalamotomy","volume":"90","author":"Hirabayashi H","year":"2012","unstructured":"Hirabayashi H, Hariz MI, W\u00e5rdell K, Blomstedt P: Impact of parameters of radiofrequency coagulation on volume of stereotactic lesion in pallidotomy and thalamotomy. Stereotact Funct Neurosurg 90:307\u2013315, 2012"},{"key":"b13","series-title":"Cereb Cortex","first-page":"31","article-title":"Functional-anatomical validation and individual variation of diffusion tractography-based segmentation of the human thalamus","volume":"15","author":"Johansen-Berg H","year":"2005","unstructured":"Johansen-Berg H, Behrens TE, Sillery E, Ciccarelli O, Thompson AJ, Smith SM, : Functional-anatomical validation and individual variation of diffusion tractography-based segmentation of the human thalamus. Cereb Cortex 15:31\u201339, 2005"},{"key":"b14","series-title":"Neurol Clin","first-page":"997","article-title":"Magnetic resonance\u2013guided focused ultrasound: a new technology for clinical neurosciences","volume":"29","author":"Jolesz F","year":"2012","unstructured":"Jolesz F, MacDannold N: Magnetic resonance\u2013guided focused ultrasound: a new technology for clinical neurosciences. Neurol Clin 29:997\u20131003, 2012"},{"key":"b15","series-title":"J Neurosurg","first-page":"162","article-title":"Different magnetic resonance imaging patterns after transcranial magnetic resonance-guided focused ultrasound of the ventral intermediate nucleus of the thalamus and anterior limb of the internal capsule in patients with essential tremor or obsessive-compulsive disorder","volume":"122","author":"Jung HH","year":"2015","unstructured":"Jung HH, Chang WS, Rachmilevitch I, Tlusty T, Zadicario E, Chang JW: Different magnetic resonance imaging patterns after transcranial magnetic resonance-guided focused ultrasound of the ventral intermediate nucleus of the thalamus and anterior limb of the internal capsule in patients with essential tremor or obsessive-compulsive disorder. J Neurosurg 122:162\u2013168, 2015"},{"key":"b16","series-title":"Surg Neurol","first-page":"307","article-title":"Thalamic spatial variability and the surgical results of lesions placed with neurophysiologic control","volume":"9","author":"Kelly PJ","year":"1978","unstructured":"Kelly PJ, Derome P, Guiot G: Thalamic spatial variability and the surgical results of lesions placed with neurophysiologic control. Surg Neurol 9:307\u2013315, 1978"},{"key":"b17","series-title":"PLoS One","first-page":"e29969","article-title":"Target identification for stereotactic thalamotomy using diffusion tractography","volume":"7","author":"Kincses ZT","year":"2012","unstructured":"Kincses ZT, Szab\u00f3 N, Val\u00e1lik I, Kopniczky Z, D\u00e9zsi L, Kliv\u00e9nyi P, : Target identification for stereotactic thalamotomy using diffusion tractography. PLoS One 7:e29969, 2012"},{"key":"b18","series-title":"N Engl J Med","first-page":"887","article-title":"Clinical practice. Essential tremor","volume":"345","author":"Louis ED","year":"2001","unstructured":"Louis ED: Clinical practice. Essential tremor. N Engl J Med 345:887\u2013891, 2001"},{"key":"b19","series-title":"Mov Disord","first-page":"534","article-title":"How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor","volume":"25","author":"Louis ED","year":"2010","unstructured":"Louis ED, Ferreira JJ: How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord 25:534\u2013541, 2010"},{"key":"b20","series-title":"J Gen Physiol","first-page":"179","article-title":"A new method for the generation and use of focused ultrasound in experimental biology","volume":"26","author":"Lynn JG","year":"1942","unstructured":"Lynn JG, Zwemer RL, Chick AJ, Miller AE: A new method for the generation and use of focused ultrasound in experimental biology. 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J Magn Reson Imaging 8:136\u2013142, 1998"},{"issue":"Suppl","key":"b23","series-title":"J Neurosurg","first-page":"234","article-title":"Gamma knife thalamotomy for movement disorders: evaluation of the thalamic lesion and clinical results","volume":"102","author":"Ohye C","year":"2005","unstructured":"Ohye C, Shibazaki T, Sato S: Gamma knife thalamotomy for movement disorders: evaluation of the thalamic lesion and clinical results. J Neurosurg 102 Suppl:234\u2013240, 2005"},{"key":"b24","series-title":"Basic Clin Neurosci","first-page":"187","article-title":"A review on brain stimulation using low intensity focused ultrasound","volume":"7","author":"Rezayat E","year":"2016","unstructured":"Rezayat E, Toostani IG: A review on brain stimulation using low intensity focused ultrasound. Basic Clin Neurosci 7:187\u2013194, 2016"},{"key":"b25","series-title":"Mov Disord","first-page":"1217","article-title":"Tractography-based ventral intermediate nucleus targeting: novel methodology and intraoperative validation","volume":"31","author":"Sammartino F","year":"2016","unstructured":"Sammartino F, Krishna V, King NK, Lozano AM, Schwartz ML, Huang Y, : Tractography-based ventral intermediate nucleus targeting: novel methodology and intraoperative validation. Mov Disord 31:1217\u20131225, 2016"},{"key":"b26","series-title":"Neurosurgery","first-page":"1124","article-title":"Diffusion tensor imaging and colored fractional anisotropy mapping of the ventralis intermedius nucleus of the thalamus","volume":"69","author":"Sedrak M","year":"2011","unstructured":"Sedrak M, Gorgulho A, Frew A, Behnke E, DeSalles A, Pouratian N: Diffusion tensor imaging and colored fractional anisotropy mapping of the ventralis intermedius nucleus of the thalamus. Neurosurgery 69:1124\u20131130, 2011"},{"key":"b27","series-title":"Mov Disord","first-page":"833","article-title":"Assessment of interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale in essential tremor","volume":"22","author":"Stacy MA","year":"2007","unstructured":"Stacy MA, Elble RJ, Ondo WG, Wu SC, Hulihan J: Assessment of interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale in essential tremor. Mov Disord 22:833\u2013838, 2007"},{"key":"b28","series-title":"AJNR Am J Neuroradiol","first-page":"891","article-title":"Imaging findings in MR imaging-guided focused ultrasound treatment for patients with essential tremor","volume":"35","author":"Wintermark M","year":"2014","unstructured":"Wintermark M, Druzgal J, Huss DS, Khaled MA, Monteith S, Raghavan P, : Imaging findings in MR imaging-guided focused ultrasound treatment for patients with essential tremor. AJNR Am J Neuroradiol 35:891\u2013896, 2014"},{"key":"b29","series-title":"Radiology","first-page":"202","article-title":"Thalamic connectivity in patients with essential tremor treated with MR imaging-guided focused ultrasound: in vivo fiber tracking by using diffusion-tensor MR imaging","volume":"272","author":"Wintermark M","year":"2014","unstructured":"Wintermark M, Huss DS, Shah BB, Tustison N, Druzgal TJ, Kassell N, : Thalamic connectivity in patients with essential tremor treated with MR imaging-guided focused ultrasound: in vivo fiber tracking by using diffusion-tensor MR imaging. Radiology 272:202\u2013209, 2014"},{"key":"b1","series-title":"Ultrasound Med Biol","first-page":"409","article-title":"Effects of physical parameters on high temperature ultrasound hyperthermia","volume":"16","author":"Billard BE","year":"1990","unstructured":"Billard BE, Hynynen K, Roemer RB: Effects of physical parameters on high temperature ultrasound hyperthermia. Ultrasound Med Biol 16:409\u2013420, 1990"},{"key":"b2","series-title":"J Neurol Neurosurg Psychiatry","first-page":"257","article-title":"Unilateral magnetic resonance guided focused ultrasound thalamotomy for essential tremor: practices and clinicoradiological outcomes","volume":"86","author":"Chang WS","year":"2015","unstructured":"Chang WS, Jung HH, Kweon EJ, Zadicario E, Rachmilevitch I, Chang JW: Unilateral magnetic resonance guided focused ultrasound thalamotomy for essential tremor: practices and clinicoradiological outcomes. J Neurol Neurosurg Psychiatry 86:257\u2013264, 2015"},{"key":"b3","series-title":"World Neurosurg","first-page":"354","article-title":"Focused ultrasound: relevant history and prospects for the addition of mechanical energy to the neurosurgical armamentarium","volume":"82","author":"Christian E","year":"2014","unstructured":"Christian E, Yu C, Apuzzo ML: Focused ultrasound: relevant history and prospects for the addition of mechanical energy to the neurosurgical armamentarium. World Neurosurg 82:354\u2013365, 2014"},{"key":"b4","series-title":"Med Phys","first-page":"2017","article-title":"Thermal dosimetry of a focused ultrasound beam in vivo by magnetic resonance imaging","volume":"26","author":"Chung AH","year":"1999","unstructured":"Chung AH, Jolesz FA, Hynynen K: Thermal dosimetry of a focused ultrasound beam in vivo by magnetic resonance imaging. Med Phys 26:2017\u20132026, 1999"},{"key":"b5","series-title":"J Neurosurg","article-title":"Noninvasive neuromodulation and thalamic mapping with low-intensity focused ultrasound","author":"Dallapiazza RF","unstructured":"Dallapiazza RF, Timbie KF, Holmberg S, Gatesman J, Lopes MB, Price RJ, : Noninvasive neuromodulation and thalamic mapping with low-intensity focused ultrasound. J Neurosurg [epub ahead of print April 21, 2017. DOI: 10.3171\/2016.11.JNS16976]"},{"key":"b6","series-title":"J Acoust Soc Am","first-page":"1641","article-title":"The effect of various physical parameters on the size and shape of necrosed tissue volume during ultrasound surgery","volume":"95","author":"Damianou C","year":"1994","unstructured":"Damianou C, Hynynen K: The effect of various physical parameters on the size and shape of necrosed tissue volume during ultrasound surgery. 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N Engl J Med 375:730\u2013739, 2016"},{"key":"b9","series-title":"Neuroimage Clin","first-page":"659","article-title":"White matter tractography for neurosurgical planning: a topography-based review of the current state of the art","volume":"15","author":"Essayed WI","year":"2017","unstructured":"Essayed WI, Zhang F, Unadkat P, Cosgrove GR, Golby AJ, O\u2019Donnell LJ: White matter tractography for neurosurgical planning: a topography-based review of the current state of the art. Neuroimage Clin 15:659\u2013672, 2017"},{"issue":"Suppl 14","key":"b10","series-title":"Mov Disord","first-page":"S259","article-title":"Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson\u2019s disease and tremor","volume":"21","author":"Gross RE","year":"2006","unstructured":"Gross RE, Krack P, Rodriguez-Oroz MC, Rezai AR, Benabid AL: Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson\u2019s disease and tremor. Mov Disord 21 (Suppl 14):S259\u2013S283, 2006"},{"key":"b11","series-title":"Stereotact Funct Neurosurg","first-page":"28","article-title":"Is there a relationship between size and site of the stereotactic lesion and symptomatic results of pallidotomy and thalamotomy?","volume":"69","author":"Hariz MI","year":"1997","unstructured":"Hariz MI, Hirabayashi H: Is there a relationship between size and site of the stereotactic lesion and symptomatic results of pallidotomy and thalamotomy? Stereotact Funct Neurosurg 69:28\u201345, 1997"},{"key":"b12","series-title":"Stereotact Funct Neurosurg","first-page":"307","article-title":"Impact of parameters of radiofrequency coagulation on volume of stereotactic lesion in pallidotomy and thalamotomy","volume":"90","author":"Hirabayashi H","year":"2012","unstructured":"Hirabayashi H, Hariz MI, W\u00e5rdell K, Blomstedt P: Impact of parameters of radiofrequency coagulation on volume of stereotactic lesion in pallidotomy and thalamotomy. Stereotact Funct Neurosurg 90:307\u2013315, 2012"},{"key":"b13","series-title":"Cereb Cortex","first-page":"31","article-title":"Functional-anatomical validation and individual variation of diffusion tractography-based segmentation of the human thalamus","volume":"15","author":"Johansen-Berg H","year":"2005","unstructured":"Johansen-Berg H, Behrens TE, Sillery E, Ciccarelli O, Thompson AJ, Smith SM, : Functional-anatomical validation and individual variation of diffusion tractography-based segmentation of the human thalamus. Cereb Cortex 15:31\u201339, 2005"},{"key":"b14","series-title":"Neurol Clin","first-page":"997","article-title":"Magnetic resonance\u2013guided focused ultrasound: a new technology for clinical neurosciences","volume":"29","author":"Jolesz F","year":"2012","unstructured":"Jolesz F, MacDannold N: Magnetic resonance\u2013guided focused ultrasound: a new technology for clinical neurosciences. Neurol Clin 29:997\u20131003, 2012"},{"key":"b15","series-title":"J Neurosurg","first-page":"162","article-title":"Different magnetic resonance imaging patterns after transcranial magnetic resonance-guided focused ultrasound of the ventral intermediate nucleus of the thalamus and anterior limb of the internal capsule in patients with essential tremor or obsessive-compulsive disorder","volume":"122","author":"Jung HH","year":"2015","unstructured":"Jung HH, Chang WS, Rachmilevitch I, Tlusty T, Zadicario E, Chang JW: Different magnetic resonance imaging patterns after transcranial magnetic resonance-guided focused ultrasound of the ventral intermediate nucleus of the thalamus and anterior limb of the internal capsule in patients with essential tremor or obsessive-compulsive disorder. 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J Magn Reson Imaging 8:136\u2013142, 1998"},{"issue":"Suppl","key":"b23","series-title":"J Neurosurg","first-page":"234","article-title":"Gamma knife thalamotomy for movement disorders: evaluation of the thalamic lesion and clinical results","volume":"102","author":"Ohye C","year":"2005","unstructured":"Ohye C, Shibazaki T, Sato S: Gamma knife thalamotomy for movement disorders: evaluation of the thalamic lesion and clinical results. J Neurosurg 102 Suppl:234\u2013240, 2005"},{"key":"b24","series-title":"Basic Clin Neurosci","first-page":"187","article-title":"A review on brain stimulation using low intensity focused ultrasound","volume":"7","author":"Rezayat E","year":"2016","unstructured":"Rezayat E, Toostani IG: A review on brain stimulation using low intensity focused ultrasound. 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