100-anniversary of the birth
Eduard Izrailevich Kandel
dedicated to
Introduction
Over the past 30 years, the treatment of nervous system diseases, primarily extrapyramidal movement disorders, using approaches of functional stereotactic neurosurgery has reached a qualitatively new level. The active implementation of the method of deep brain stimulation deep brain stimulation, DBS), the refinement of traditional destructive stereotactic surgeries and the emergence of non-invasive methods for precision ablation of cerebral targets have dramatically changed the face of modern neurology. Today, it is difficult to imagine managing patients with Parkinson’s disease (PD), essential tremor (ET), dystonias, and many other conditions without these familiar surgical technologies, which help overcome severe disability and significantly improve patients’ quality of life
It would not be an exaggeration to say that one of the most striking innovations in this rapidly developing field of neuroscience has been the development of the MRI-guided focused ultrasound (MRgFUS) method. It represents a unique alternative to traditional ablative functional interventions. The MRgFUS method allows for non-invasive targeted impact on a specific point deep within the brain by focusing hundreds of ultrasound beams simultaneously directed at the target from an external spherical emitting device. And if the artistic symbol and emblem of stereotactic neurosurgery is traditionally considered to be the image of Wilhelm Tell hitting an apple on a boy’s head with a crossbow (illustration), then MRgFUS can probably be compared to another weapon—a bundle of invisible “magic arrows” from popular computer games, inevitably striking the intended target. Dedicated to the 100th anniversary of the birth of Eduard Israilevich Kandel
The method of directed ultrasound impact on the brain has a long history, but it was implemented at the modern technological level 15 years ago: the first operation using MRgFUS was performed in 2009. Today, the method is mainly used in patients with extrapyramidal pathology. Thanks to the official approval of the U.S. Food and Drug Administration, the European Medicines Agency, Roszdravnadzor, and other authorities, the MRgFUS method is now becoming increasingly widespread worldwide. If in 2018, the milestone of the 1000th patient was reported, by today the total number of patients with ET and PD treated with the MRgFUS method has already exceeded 15,000. And this is far from the limit. For example, a very indicative fact: in 2021, for the first time in the U.S., the number of ET patients operated on using MRgFUS exceeded the number of patients with this diagnosis referred for DBS. The total number of operational MRgFUS installations in different countries worldwide in 2024 exceeded 150. In the Russian Federation, 4 clinics already have such installations (2 in Moscow, and 1 each in Saint Petersburg and Ufa), and there is no doubt that their number will gradually increase.
The obvious advantages of MRgFUS over other methods of stereotactic interventions on the brain are the absence XIX century. (From: Collected Works of Schiller in Translations by Russian Writers. Edited by S.A. Vengerov. St. Petersburg: Brockhaus-Efron; 1901. Vol. 1. 480 p.) incisions, trepanation of the skull, anesthesia, implantation of foreign bodies, and the associated various complications. MRI-guideded focused ultrasound does not require a sterile operating room, and the clinical result of the intervention can be assessed directly during the operation. The effect of ultrasound ablation performed by the MRgFUS method can be preliminarily modeled during trial sonications at lower temperatures, with the temperature regime at the target point being controlled in real-time. All this allows for maximum precise targeting and thus achieving an optimal response to treatment. The safety of the procedure and the ability to model the clinical effect have led to the reintroduction of bilateral ablations for ET and other diseases in functional stereotactic neurosurgery, which were considered unacceptable for many years due to the risk of severe complications.
The pioneer of MRgFUS in our country was the V.S. Buzaev International Medical Centre in Ufa, whose specialists successfully performed the first operation using this technology on a patient with PD on May 5, 2020. This work is conducted under the scientific and methodological guidance and in close cooperation with the Research Center of Neurology (Moscow). To date, the total number of patients operated on at the V.S. Buzaev International Medical Centre with various central nervous system (CNS) diseases is approaching 200, with a number of our proposed innovations and developments having global priority. We present this extensive experience in the current monograph and hope it will be very useful for all our colleagues interested in mastering the MRgFUS method or interested in issues related to the treatment of movement disorders.
It is symbolic that the monograph on MRgFUS is being published just a few months after the scientific medical community solemnly celebrated the 100th anniversary of the founder of functional and stereotactic neurosurgery in our country and one of the leaders in this field worldwide, the creator and long-time head of the neurosurgical department of the Neurology Research Institute of the USSR Academy of Medical Sciences (now the Scientific Center of Neurology), Professor Eduard Israilevich Kandel. A true innovator in neurosurgery, he left a bright creative legacy. That is why we dedicate the first publication in our country on this breakthrough, innovative stereotactic technology to his memory.
The authors express deep gratitude for the continuous support in their work to Doctor of Medical Sciences Igor Vyacheslavovich Buzaev, professor of the Department of Hospital Surgery at the Federal State Budgetary Educational Institution of Higher Education “Bashkir State Medical University” of the Ministry of Health of Russia, one of the founders of the Intelligent Neurosurgery Clinic, Ltd at the V.S. Buzaev International Medical Centre. The method of treating patients using focused ultrasound without incisions, pain, and anesthesia inspired him in 2017: it resonated with the ideas that his father, Vyacheslav Stepanovich Buzaev – Doctor of Medical Sciences, founder of the interventional radiology school in the Republic of Bashkortostan, who performed the first coronary angiographies, coronary artery stenting, emergency endovascular treatment of acute myocardial infarction in the republic and transitioned from open to minimally invasive cardiovascular surgery, had advocated throughout his life. Seeing a technology that combines humanity, progressive medical development, and a change in the philosophy of medical care, I.V. Buzaev made every effort to open the first MRgFUS center in the Russian Federation. This monograph was written with his assistance.
The authors express special gratitude to Ildar Dinarovich Khalfin, who believed in the potential of MRgFUS technology, became one of the founders of our center, and continues to make a significant contribution to its development, the expansion of the geographical reach of patients, and staff training. Many years ago, faced with the inability to help a loved one with a movement disorder, he took on the challenge of opening the first MRgFUS clinic in Russia, where the dream of alleviating severe suffering became possible!