We describe a 74-year-old male with intractable essential tremor (ET) and hyperostosis calvariae diffusa who was unsuccessfully treated with magnetic resonance-guided focused ultrasound (MRgFUS). A computed tomography performed prior to the procedure demonstrated a skull density ratio (SDR) of 0.37 and tricortical hyperostosis calvariae diffusa. No lesion was evident on post-MRgFUS MRI, and no improvement in the patient’s hand tremor was noted clinically. We systematically reviewed the literature to understand outcomes for those patients with hyperostosis who have undergone MRgFUS. A comprehensive literature search using the PubMed, Cochrane, and Google Scholar databases identified 3 ET patients with hyperostosis who failed treatment with MRgFUS. Clinical findings, skull characteristics, treatment parameters, and outcomes were summarized, demonstrating different patterns/degrees of bicortical hyperostosis and variable SDRs (i.e., from 0.38 to ≥0.45). Although we have successfully treated patients with bicortical hyperostosis frontalis interna (n = 50), tricortical hyperostosis calvariae diffusa appears to be a contraindication for MRgFUS despite acceptable SDRs.

Keywords:
MR-guided focused ultrasound, Essential tremor, Hyperostosis calvariae diffusa, Skull density ratio, Skull volume
1.
Chang WS, Jung HH, Kweon EJ, Zadicario E, Rachmilevitch I, Chang JW. Unilateral magnetic resonance guided focused ultrasound thalamotomy for essential tremor: practices and clinicoradiological outcomes. J Neurol Neurosurg Psychiatry. 2015;86(3):257–64.
2.
Bond AE, Shah BB, Huss DS, Dallapiazza RF, Warren A, Harrison MB, et al. Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial. JAMA Neurol. 2017;74(12):1412–8.
3.
Chazen JL, Sarva H, Stieg PE, Min RJ, Ballon DJ, Pryor KO, et al. Clinical improvement associated with targeted interruption of the cerebellothalamic tract following MR-guided focused ultrasound for essential tremor. J Neurosurg. 2018;129(2):315–23.
4.
Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, et al. A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2016;375(8):730–9.
5.
Chang WS, Jung HH, Zadicario E, Rachmilevitch I, Tlusty T, Vitek S, et al. Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull. J Neurosurg. 2016;124(2):411–6.
6.
Mueller JK, Ai L, Bansal P, Legon W. Numerical evaluation of the skull for human neuromodulation with transcranial focused ultrasound. J Neural Eng. 2017;14(6):066012.
7.
Wang TR, Bond AE, Dallapiazza RF, Blanke A, Tilden D, Huerta TE, et al. Transcranial magnetic resonance imaging-guided focused ultrasound thalamotomy for tremor: technical note. Neurosurg Focus. 2018;44(2):E3.
8.
Jung NY, Rachmilevitch I, Sibiger O, Amar T, Zadicario E, Chang JW. Factors related to successful energy transmission of focused ultrasound through a skull: a study in human cadavers and its comparison with clinical experiences. J Korean Neurosurg Soc. 2019;62(6):712–22.
9.
McDannold N, White PJ, Cosgrove R. Predicting bone marrow damage in the skull after clinical transcranial MRI-guided focused ultrasound with acoustic and thermal simulations. IEEE Trans Med Imaging. 2020;39(10):3231–9.
10.
Lai S, Tomer N. Hyperostosis fronto-parietalis - radiology mimic of metastasis: a case report. Radiol Case Rep. 2021;16(8):2244–7.
11.
Raikos A, Paraskevas GK, Yusuf F, Kordali P, Meditskou S, Al-Haj A, et al. Etiopathogenesis of hyperostosis frontalis interna: a mystery still. Ann Anat Anatomischer Anzeiger. 2011;193(5):453–8.
12.
Hershkovitz I, Greenwald C, Rothschild BM, Latimer B, Dutour O, Jellema LM, et al. Hyperostosis frontalis interna: an anthropological perspective. Am J Phys Anthropol. 1999;109(3):303–25.
13.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
14.
Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res. 2020;7(1):7.
15.
Yuen J, Miller KJ, Klassen BT, Lehman VT, Lee KH, Kaufmann TJ. Hyperostosis in combination with low skull density ratio: a potential contraindication for magnetic resonance imaging-guided focused ultrasound thalamotomy. Mayo Clinic Proc Innov Qual Outcomes. 2022;6(1):10–5.
16.
Boutet A, Gwun D, Gramer R, Ranjan M, Elias GJB, Tilden D, et al. The relevance of skull density ratio in selecting candidates for transcranial MR-guided focused ultrasound. J Neurosurg. 2020;132(6):1785–91.
17.
Chang JW, Park CK, Lipsman N, Schwartz ML, Ghanouni P, Henderson JM, et al. A prospective trial of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor: results at the 2-year follow-up. Ann Neurol. 2018;83(1):107–14.
18.
Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. Epub.
19.
Davidson B, Hamani C, Huang Y, Jones RM, Meng Y, Giacobbe P, et al. Magnetic resonance-guided focused ultrasound capsulotomy for treatment-resistant psychiatric disorders. Oper Neurosurg. 2020;19(6):741–9.
20.
Chazen JL, Stavarache M, Kaplitt MG. Cranial MR-guided focused ultrasound: clinical challenges and future directions. World Neurosurg X. 2021;145:574–80.
21.
Meng Y, Jones RM, Davidson B, Huang Y, Pople CB, Surendrakumar S, et al. Technical principles and clinical workflow of transcranial MR-guided focused ultrasound. Stereotact Funct Neurosurg. 2021;99(4):329–42.
22.
Elble RJ, Shih L, Cozzens JW. Surgical treatments for essential tremor. Expert Rev Neurother. 2018;18(4):303–21.
23.
McDannold NJ, King RL, Jolesz FA, Hynynen KH. Usefulness of MR imaging-derived thermometry and dosimetry in determining the threshold for tissue damage induced by thermal surgery in rabbits. Radiology. 2000;216(2):517–23.
24.
Tsai KW, Chen JC, Lai HC, Chang WC, Taira T, Chang JW, et al. The distribution of skull score and skull density ratio in tremor patients for MR-guided focused ultrasound thalamotomy. Front Neurosci. 2021;15:612940.
25.
Fry FJ, Barger JE. Acoustical properties of the human skull. J Acoust Soc Am. 1978;63(5):1576–90.
26.
Wilson DN, Barnett Y, Kyle K, Tisch S, Jonker BP. Predictors of thermal response and lesion size in patients undergoing magnetic resonance-guided focused ultrasound thalamotomy. J Clin Neurosci. 2021;91:75–9.
27.
Chang KW, Park YS, Chang JW. Skull factors affecting outcomes of magnetic resonance-guided focused ultrasound for patients with essential tremor. Yonsei Med J. 2019;60(8):768–73.
28.
Pulkkinen A, Werner B, Martin E, Hynynen K. Numerical simulations of clinical focused ultrasound functional neurosurgery. Phys Med Biol. 2014;59(7):1679–700.
29.
Schwartz ML, Yeung R, Huang Y, Lipsman N, Krishna V, Jain JD, et al. Skull bone marrow injury caused by MR-guided focused ultrasound for cerebral functional procedures. J Neurosurg. 2019;130(3):758–62.
© 2022 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2022
You do not currently have access to this content.