• Guidelines


    ASSFN Position Statement on MR-guided Focused Ultrasound for the Management of Essential Tremor

    Nader Pouratian, MD, PhD
    Gordon Baltuch, MD, PhD
    W. Jeff Elias, MD
    Robert Gross, MD, PhD
    on behalf of the American Society for Stereotactic and Functional Neurosurgeons (ASSFN)

    Executive Summary

    Purpose of the Statement

    1. To provide an evidence-based best practices summary to guide health care providers in the use of MR-guided Focused Ultrasound (MRgFUS) in the management of essential tremor
    2. To establish expert consensus opinion and areas requiring additional investigation

    Importance of the ASSFN Statement

    1. Stereotactic and functional neurosurgeons are involved in the care of patients with advanced, medically refractory essential tremor
    2. Stereotactic and functional neurosurgeons are domain-specific experts in the specialty literature and the practical use of stereotactic procedures for the management of essential tremor and other neuropsychiatric disorders.
    3. Stereotactic and functional neurosurgeons are domain-specific experts in comparative assessment of benefits, risks, and alternatives of stereotactic procedures for the management of patients with essential tremor and other neuropsychiatric diagnoses.

    Indications for the use of MRgFUS as a treatment option for patients with essential tremor include all of the following criteria:

    1. Confirmed diagnosis of ET
    2. Failure to respond to, intolerance of, or medical contraindication to use of at least two medications for ET, one of which must be a first line medication.
    3. Appendicular tremor that interferes with quality of life based on clinical history
    4. Unilateral treatment

    Contraindication to use of MRgFUS:

    1. Bilateral MRgFUS thalamotomy
    2. Contralateral to a previous thalamotomy
    3. Cannot undergo MRI due to medical reasons
    4. Skull density ratio (ratio of cortical to cancellous bone) is <0.40

    Recommendations are based on:

    1. Safety and efficacy demonstrated in a single randomized, sham-surgery controlled double-blind clinical trial (RCT) and several uncontrolled clinical trials
    2. Dearth of direct comparative studies between different surgical treatment modalities and the unlikelihood that such comparative studies will be performed due to differences in indications, patient preference, and follow-up requirements

    Full statement


  • Clincal Cases and Techniques


    STN DBS for Parkinson's

    ASSFN Clinical Case:
    Bilateral STN DBS Implant for Parkinson’s Disease.
    Click here for full case


    Surgery for Essential Tremor

    Case Illustration: Essential Tremor (ET)
    Ellen L. Air, M.D., Ph.D
    Senior Staff, Henry Ford Health System and Clinical Instructor, Wayne State University
    Detroit, MI
    Click here for full case


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