Anesthesia Management for High-Intensity Focused Ultrasound (HIFU) Thalamotomy for Movement Disorders: A Case Series from the National University Hospital of the Philippines

Abstract

An increasing number of neurological conditions may be treated with high-intensity focused ultrasound (HIFU), among which is geared towards the control of tremors as seen in patients with Parkinson’s Disease (PD), X-linked Dystonia Parkinsonism (XDP), and Essential Tremor (ET). HIFU thalamotomy is a noninvasive therapy for neurological conditions with debilitating tremors despite medication. To improve treatment accuracy and patient safety, neurosurgeons, neurologists, and anesthesiologists must work together perioperatively.

A total of 30 patients detailing their demographics, symptoms, and perioperative anesthetic management in a tertiary government hospital in Metro Manila was reviewed from October 2021 to March 2024. Most of the patients were diagnosed as PD tremor dominant, followed by XDP and ET. Majority of the cases were done under minimal sedation with local infiltration on the pin site while the rest were done under monitored anesthesia care combined with local anesthesia. Specific anesthetic agents were given to provide comfort and pain relief and reduce the risk of side effects.

During sonication, an essential element of the procedure, patients were closely monitored for the anticipated effects, such as paresthesia, headache, nausea, and vomiting, and were managed accordingly. Postoperatively, these patients were reported to have decreased tremors, stable vital signs, and adequate pain control. Collaboration among healthcare providers is one of the important elements for a successful outcome. This study highlights the importance of personalized anesthetic management in enhancing patient outcomes and the need for future studies about developing anesthesia protocols and strategies.