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Magnetic ResonanceGuided Focused Ultrasound Surgery: Part 2: A Review of Current and Future Applications

Medel, Ricky MD*; Monteith, Stephen J. MD*; Elias, W. Jeffrey MD*; Eames, Matthew PhD§; Snell, John PhD§; Sheehan, Jason P. MD, PhD*; Wintermark, Max MD, MAS; Jolesz, Ferenc A. MD; Kassell, Neal F. MD*,§

doi: 10.1227/NEU.0b013e3182672ac9

Magnetic resonance–guided focused ultrasound surgery (MRgFUS) is a novel combination of technologies that is actively being realized as a noninvasive therapeutic tool for a myriad of conditions. These applications are reviewed with a focus on neurological use. A combined search of PubMed and MEDLINE was performed to identify the key events and current status of MRgFUS, with a focus on neurological applications. MRgFUS signifies a potentially ideal device for the treatment of neurological diseases. As it is nearly real time, it allows monitored provision of treatment location and energy deposition; is noninvasive, thereby limiting or eliminating disruption of normal tissue; provides focal delivery of therapeutic agents; enhances radiation delivery; and permits modulation of neural function. Multiple clinical applications are currently in clinical use and many more are under active preclinical investigation. The therapeutic potential of MRgFUS is expanding rapidly. Although clinically in its infancy, preclinical and early-phase I clinical trials in neurosurgery suggest a promising future for MRgFUS. Further investigation is necessary to define its true potential and impact.

ABBREVIATIONS: BBB, blood–brain barrier

HIFU, high-intensity focused ultrasound

MRgFUS, magnetic resonance–guided focused ultrasound surgery

tPA, tissue plasminogen activator

Departments of *Neurosurgery and

Radiology, University of Virginia Health Sciences Center, University of University, Charlottesville, Virginia

§Focused Ultrasound Surgery Foundation, Charlottesville, Virginia

Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Correspondence: Neal F. Kassell, MD, Department of Neurological Surgery, University of Virginia Health Sciences Center, Box 800212, Charlottesville, VA 22902. E-mail:

Received March 19, 2012

Accepted June 20, 2012

Copyright © by the Congress of Neurological Surgeons