Is It Safe to Have Deep Brain Stimulation after MRI-Guided Focused Ultrasound Ablation? A Report of Three Cases and Review of Literature.
Overview
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
Abstract
Introduction: MRI-guided focused ultrasound (MRgFUS) ablation has become increasingly utilised for movement disorders since its approval by the US Food and Drug Administration (FDA) in the treatment of unilateral essential tremor (ET) in 2016. While most patients achieve significant improvement in their symptoms, a proportion of ET patients experience tremor recurrence. Deep brain stimulation (DBS) is a potential rescue therapy post-MRgFUS. However, the safety profile of such scenarios is currently unknown.
Case Presentations: Here, we report 3 ET patients who previously underwent MRgFUS of the ventral intermediate nucleus of the thalamus (Vim) and subsequently had DBS insertion due to tremor recurrence. Three patients (ranging from 58 to 85 years of age; one female) presented with a history of refractory ET. Patient 1 had left Vim MRgFUS and then left Vim DBS. However, the tremor control was still inadequate, and he had a further revision DBS surgery where two electrodes were inserted into left Vim. Patient 2 had two MRgFUS procedures in left Vim and then underwent left Vim DBS insertion due to hand tremor recurrence. Patient 3 had left Vim MRgFUS and then bilateral Vim DBS due to midline tremor. Patients 2 and 3 experienced substantial improvement in symptoms after DBS, but patient 1 only had minimal improvement. There were no surgical complications and no readmission within 30 days.
Conclusions: This case series demonstrates that insertion of DBS electrodes in the vicinity of prior MRgFUS site can be safe. These findings have important implications for pre-operative counselling of patients with ET with high surgical risks, as well as supporting MRgFUS as a first-line therapy in selected patients. Further studies with larger population will delineate the optimal timeline where DBS may be safely performed in this population, as well as the long-term therapeutic effect of such rescue intervention.
Reproduced under the paper's license (CC BY-NC), from the paper cited above.
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Data
Datasets cited
- figshare:31554640, at figshare; found in DataCite
Data Availability Statement
All data generated or analysed during this study are included in this article and its online supplementary material. Further enquiries may be directed to the corresponding author.
Reproduced under the paper's license (CC BY-NC), from the paper cited above.
Versions
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Version 1, 30 September 2026: the first record
Recorded: type, language, journal, pages, dates, 8 authors, 5 keywords, 38 references.
Cite
This paper
Yuen, J., Khayat, H., Fakhroo, F. A., Buongermini, R., Germann, J., Boutet, A., Fasano, A., & Lozano, A. M. (2026). Is It Safe to Have Deep Brain Stimulation after MRI-Guided Focused Ultrasound Ablation? A Report of Three Cases and Review of Literature. Stereotactic and functional neurosurgery, 1-9. https://
BibTeX
@article{yuen2026it,
author = {Yuen, Jason and Khayat, Hassan and Fakhroo, Fatima A and Buongermini, Rafael and Germann, Jurgen and Boutet, Alexandre and Fasano, Alfonso and Lozano, Andres M},
title = {{Is It Safe to Have Deep Brain Stimulation after MRI-Guided Focused Ultrasound Ablation? A Report of Three Cases and Review of Literature}},
journal = {Stereotactic and functional neurosurgery},
year = {2026},
month = mar,
pages = {1--9},
publisher = {Karger Publishers},
issn = {1011-6125},
doi = {10.1159/
url = {https://
pmid = {41790583},
pmcid = {PMC13155732}
}
RIS
TY - JOUR
AU - Yuen, Jason
AU - Khayat, Hassan
AU - Fakhroo, Fatima A
AU - Buongermini, Rafael
AU - Germann, Jurgen
AU - Boutet, Alexandre
AU - Fasano, Alfonso
AU - Lozano, Andres M
TI - Is It Safe to Have Deep Brain Stimulation after MRI-Guided Focused Ultrasound Ablation? A Report of Three Cases and Review of Literature
T2 - Stereotactic and functional neurosurgery
J2 - Stereotact Funct Neurosurg
PY - 2026
DA - 2026/
SP - 1
EP - 9
SN - 1011-6125
PB - Karger Publishers
DO - 10.1159/
UR - https://
LA - en
ER -
CSL-JSON
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"language": "en",
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