Role of High-Intensity Focused Ultrasound for Functional Neurosurgery and for the Management of Brain Lesions

MRI-guided focused ultrasound (MRgFUS) is increasingly used in lesioning for functional neurosurgery and neuro-oncology. Technological advances in transducer design and MR thermometry has allowed for the noninvasive lesioning of deep-seated structures under real-time monitoring. MRgFUS has received FDA approval for the treatment of medication-refractory essential tremor and tremor or dyskinesia in Parkinson's disease. These indications might soon expand to include neuropathic pain, obsessive-compulsive disorder, and major depressive disorder, with the culmination of clinical studies currently underway. In the field of neuro-oncology, sonodynamic ablation and histotripsy might help overcome the inherent limitations of the currently available MRgFUS technology in regard to tumor ablation. FUS-mediated blood–brain barrier disruption is also being currently investigated as a mean toward enhancing the availability of chemotherapeutic agents.