Transcranial Magnetic Resonance-Guided Focused Ultrasound Surgery for Brain Tumor Ablation: Are We Ready for This Challenging Treatment?

Abstract

The treatment of high-grade gliomas (HGGs) remains a challenge for modern therapy. The prognosis for these patients has been poor. The median patient survival after diagnosis has been ∼1 year with surgery and/or radiotherapy and temozolomide.1 The need for a histological diagnosis of tumor tissue in each case and the importance of decompression in symptomatic patients are well established, and extensive surgical resection has been shown to significantly prolong survival. Several factors play a role in the prognosis of patients with HGG, including age, performance status using the Karnofsky performance scale, and the extent of resection.2, 3 At present, the standard therapy for HHG consists of maximal surgical resection of the tumor, followed by radiotherapy 2–4 weeks postoperatively and then by chemotherapy.1 Minimally invasive techniques are becoming the dominant trend in neurosurgical oncology, and the use of electrophysiological monitoring even during awake surgery has improved the clinical outcomes of these patients. Temozolomide has been shown to improve overall survival and progression-free survival when given concurrently with RT in patients with newly diagnosed HGG.3 However, 1 of the major obstacles to effective chemotherapy for brain tumors is the blood–brain barrier (BBB), which hinders the penetration of most therapeutic compounds into the central nervous system. Accordingly, the current research has been aimed at the BBB opening for drug delivery because complete tumor ablation has remained extremely challenging. In addition, patients...