Staged bilateral MR-guided focused ultrasound thalamotomy in a patient with cerebral cavernous malformations.
Matthew C Henn, Daniel R Cleary
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Case in brief
A man in his late 60s with medication-refractory essential tremor was found on preoperative MRI to have cavernous malformations in the left caudate head and basal ganglia, with an associated developmental venous anomaly and no history of haemorrhage. After counselling about uncertain procedural risks, he underwent right-sided MR-guided focused ultrasound thalamotomy, followed one year later by left-sided thalamotomy. MRI after both procedures showed expected treatment-related changes, without acute haemorrhage around the malformations.
What made this case unusual
The case describes staged bilateral MR-guided focused ultrasound thalamotomy in a patient with cerebral cavernous malformations, an intracranial comorbidity for which procedural safety data are limited.
Diagnostic / clinical pearl
Cavernous malformations may not automatically preclude MR-guided focused ultrasound thalamotomy in carefully selected patients; individualised counselling, preoperative planning and MRI surveillance are important.