Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed
CPT4 code
Name of the Procedure:
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS), Stereotactic Ablation Lesion, Intracranial for Movement Disorder, including Stereotactic Navigation and Frame Placement
Summary
MRgFUS is a non-invasive procedure that uses focused ultrasound waves, guided by magnetic resonance imaging (MRI), to target and ablate specific areas of the brain responsible for movement disorders. This technique involves precise navigation and frame placement to ensure the accuracy of the treatment.
Purpose
MRgFUS is primarily used to treat movement disorders like essential tremor, Parkinson's disease, and tremor-dominant multiple sclerosis. The goal is to alleviate symptoms such as tremors and involuntary movements, thereby improving the patient's quality of life.
Indications
- Essential tremor
- Parkinson's disease with tremor-dominant symptoms
- Tremor-dominant multiple sclerosis
- Patients who have not responded to medication or other less invasive treatments
Preparation
- Fasting for a certain period before the procedure
- Adjusting certain medications under a doctor’s guidance
- Pre-procedure MRI scans and neurological assessments to map the treatment area
Procedure Description
- The patient’s head is secured in a stereotactic frame to prevent movement.
- Advanced imaging techniques, including MRI, are used to precisely locate the target area.
- Focused ultrasound waves are delivered to the targeted brain tissue through the skull, heating and destroying the problematic tissue.
- MRI guidance ensures real-time monitoring of the treatment area to maximize precision.
- No incisions are made, and the skull remains intact.
Duration
The procedure typically takes between 3 to 4 hours.
Setting
The procedure is performed in a hospital or a specialized outpatient clinic equipped with MRI and focused ultrasound technology.
Personnel
- Neurosurgeon
- Radiologist
- Anesthesiologist (if sedation is required)
- MRI technologist
- Nursing staff
Risks and Complications
- Common risks: headache, nausea, temporary discomfort from the stereotactic frame
- Rare risks: bleeding, infection, unintended damage to surrounding brain tissue, neurological deficits
- Potential complications: difficulty swallowing, balance issues, limb weakness
Benefits
- Significant reduction or complete elimination of tremors
- Improved motor function and daily living activities
- Immediate symptom relief in many cases
Recovery
- Observation for a few hours post-procedure
- Discharge home on the same day or the next
- Follow-up appointments to monitor progress
- Restrictions on strenuous activities for a short period
Alternatives
- Medication management
- Deep brain stimulation (DBS)
- Radiofrequency ablation
- Pros and cons: MRgFUS is non-invasive compared to DBS and radiofrequency ablation, with a shorter recovery time, though it may not be suitable for all patients.
Patient Experience
During the procedure, patients might feel slight discomfort due to the frame placement but are typically awake and alert. Post-procedure, some may experience mild headache or nausea, which is manageable with medication. Most patients begin to see symptom improvement shortly after the procedure.