Internal medicine

Radiology

Pathology

Adverse effect

Disease

Capsulotomy

Focused ultrasound

Magnetic resonance imaging

Surgery

Ultrasound

Intraocular lens

Parkinson's disease

Deep brain stimulation

Radiosurgery

Radiation therapy

Medicine

Operative Neurosurgery

BACKGROUND Psychiatric surgery is an important domain of functional neurosurgery and involves deep brain stimulation (DBS) or lesional procedures performed for treatment-resistant psychiatric illness. It has recently become possible to use magnetic-guided focused ultrasound (MRgFUS) to perform bilateral capsulotomy, a lesional technique commonly carried out with surgical radiofrequency ablation or stereotactic radiosurgery. MRgFUS offers several advantages, including improved safety and real-time imaging of the lesions. OBJECTIVE To describe the clinical and technical aspects of performing bilateral MRgFUS capsulotomy in patients with severe refractory depression and obsessive-compulsive disorder. METHODS We describe the clinical and technical considerations of performing MRgFUS capsulotomy. Topics discussed include patient selection, headframe application, targeting, sonication strategies, and follow-up procedures. RESULTS MRgFUS capsulotomy was performed in 16 patients without serious clinical or radiographic adverse events. CONCLUSION MRgFUS allows for a safe, less invasive technique for performing a well-studied psychiatric surgery procedure—the anterior capsulotomy.

Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders