Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders

Background Psychiatric surgery is an important domain of functional neurosurgery and involves deep brain stimulation (DBS) or lesional procedures performed for treatment-resistant psychiatric illness. It has recently become possible to use magnetic-guided focused ultrasound (MRgFUS) to perform bilateral capsulotomy, a lesional technique commonly carried out with surgical radiofrequency ablation or stereotactic radiosurgery. MRgFUS offers several advantages, including improved safety and real-time imaging of the lesions. Objective To describe the clinical and technical aspects of performing bilateral MRgFUS capsulotomy in patients with severe refractory depression and obsessive-compulsive disorder. Methods We describe the clinical and technical considerations of performing MRgFUS capsulotomy. Topics discussed include patient selection, headframe application, targeting, sonication strategies, and follow-up procedures. Results MRgFUS capsulotomy was performed in 16 patients without serious clinical or radiographic adverse events. Conclusion MRgFUS allows for a safe, less invasive technique for performing a well-studied psychiatric surgery procedure-the anterior capsulotomy.