{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T07:50:32Z","timestamp":1784965832689,"version":"3.55.0"},"reference-count":72,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>MR-guided focused ultrasound anterior capsulotomy (MRgFUS-AC) is an incisionless ablative procedure, which has shown reassuring safety and compelling efficacy in the treatment of refractory obsessive-compulsive disorder and major depressive disorder. However, in some patients lesions cannot be reliably generated due to patient-specific skull morphologies and properties. Despite screening patients for MRgFUS-AC using skull density ratio (SDR), up to 25% of cases experience treatment failure. This variability in technical success limits the real-world applicability of an otherwise highly impactful treatment, and a better predictor of success is needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This study analyzed data from 60 attempted MRgFUS-AC treatments in 57 patients between 2017 and 2024. Treatments were categorized as success or failure based on lesion volume. Preoperative parameters, including SDR, skull thickness, angle of incidence, CSF volume, brain and head volumes, and lesion side, were recorded. Logistic and machine learning models were evaluated to construct a preoperative model to predict the probability of technical success.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 157 lesions were treated, of which 31 experienced treatment failure. Higher SDR, thinner skulls, and lower incident angles were significantly associated with successful outcomes (all p &lt; 0.05). The logistic regression model performed the best among the models tested, with an accuracy of 0.81 \u00b1 0.07 and an F1 score of 0.89 \u00b1 0.04. The model was incorporated into a predictive tool to aid in identifying candidates for MRgFUS-AC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>SDR, skull thickness, and angle of incidence significantly influenced the likelihood of successful MRgFUS-AC lesioning. Incorporating these three parameters into a predictive tool can dramatically reduce technical failure rates and may be especially informative in patients with an SDR between 0.35 and 0.55.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.6.jns2588","type":"journal-article","created":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:38:57Z","timestamp":1760146737000},"page":"94-103","source":"Crossref","is-referenced-by-count":2,"title":["Focused ultrasound capsulotomy: predicting the probability of successful lesioning based on skull morphology"],"prefix":"10.3171","volume":"144","author":[{"given":"Emmanuel","family":"De Schlichting","sequence":"first","affiliation":[{"name":"Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuexi","family":"Huang","sequence":"additional","affiliation":[{"name":"Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan M.","family":"Jones","sequence":"additional","affiliation":[{"name":"Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Meng","sequence":"additional","affiliation":[{"name":"Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto;"},{"name":"Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto;"},{"name":"Institute of Medical Sciences, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingshan","family":"Cao","sequence":"additional","affiliation":[{"name":"Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anusha","family":"Baskaran","sequence":"additional","affiliation":[{"name":"Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kullervo","family":"Hynynen","sequence":"additional","affiliation":[{"name":"Physical Sciences Platform, Sunnybrook Research Institute, Toronto;"},{"name":"Department of Medical Biophysics, University of Toronto;"},{"name":"Institute of Biomedical Engineering, University of Toronto; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clement","family":"Hamani","sequence":"additional","affiliation":[{"name":"Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto;"},{"name":"Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto;"},{"name":"Institute of Medical Sciences, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Lipsman","sequence":"additional","affiliation":[{"name":"Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto;"},{"name":"Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto;"},{"name":"Institute of Medical Sciences, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maged","family":"Goubran","sequence":"additional","affiliation":[{"name":"Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto;"},{"name":"Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto;"},{"name":"Physical Sciences Platform, Sunnybrook Research Institute, Toronto;"},{"name":"Department of Medical Biophysics, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Davidson","sequence":"additional","affiliation":[{"name":"Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto;"},{"name":"Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"JAMA Neurol","first-page":"1412","article-title":"Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial","volume":"74","author":"Bond AE","year":"2017","unstructured":"Bond AE, Shah BB, Huss DS,  Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial. 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A study of novel bilateral thermal capsulotomy with focused ultrasound for treatment-refractory obsessive\u2013compulsive disorder: 2-year follow-up. J Psychiatry Neurosci. 2018;43(5):327\u2013337."},{"issue":"7","key":"b14","series-title":"Biol Psychiatry","first-page":"698","article-title":"Long-term safety and efficacy of focused ultrasound capsulotomy for obsessive-compulsive disorder and major depressive disorder","volume":"97","author":"Hamani C","year":"2025","unstructured":"Hamani C, Davidson B, Rabin JS,  Long-term safety and efficacy of focused ultrasound capsulotomy for obsessive-compulsive disorder and major depressive disorder. 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What factors impact the clinical outcome of magnetic resonance imaging\u2013guided focused ultrasound thalamotomy for essential tremor?. J Neurosurg. 2021;134(5):1618\u20131623."},{"issue":"7","key":"b32","series-title":"Med Phys","first-page":"2925","article-title":"The reduction in treatment efficiency at high acoustic powers during MR-guided transcranial focused ultrasound thalamotomy for Essential Tremor","volume":"45","author":"Hughes A","year":"2018","unstructured":"Hughes A, Huang Y, Schwartz ML, Hynynen K. The reduction in treatment efficiency at high acoustic powers during MR-guided transcranial focused ultrasound thalamotomy for Essential Tremor. 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