For the first time, multidisciplinary teams from five Italian sites convened to share experiences, research, and best practices in focused ultrasound for neurological disorders. More than 100 people attended the workshop – including neurosurgeons, neurologists, neuroradiologists, general practitioners, residents, and fellows in training as well as representatives from the governmental health agencies – which was organized by Cesare Gagliardo, MD, of the University of Palermo and Alessandro Napoli, MD, PhD, from La Sapienza University in Rome.
Since the first patient was treated with focused ultrasound in Palermo in January 2015, more than 200 patients with neurological disorders have been treated in Italy.
The workshop spanned two days. The first day provided an overview of MR-guided focused ultrasound (MRgFUS) technical parameters, targeting for essential tremor, and future perspectives of emerging clinical applications.
- Prof. Maurizio Marrale from the University of Palermo provided an overview of MRI for anatomic guidance and thermal monitoring during focused ultrasound ablation.
- Prof. Alessandro Napoli reviewed his focused ultrasound ablation experiences with numerous clinical body applications including uterine fibroids, bone metastases, and pancreatic cancer.He also recalled how the first Italian focused ultrasound system for the brain was installed in Palermo through a long standing and fruitful collaboration between the Department of Radiology of the La Sapienza University in Rome, led by Professor C. Catalano, and the Department of Radiology of the University of Palermo led by Prof. M. Midiri.
- Prof. Marcello D’Amelio from the University of Palermo presented the clinical features of essential tremor, possible treatment options, and discussed the criteria to select the best candidate for MRgFUS treatments for ablation of the Vim nucleus.
- Prof. Wladyslaw Gedroyc from Imperial College London described the clinical improvement in tremor when expanding the target beyond the Vim nucleus to include the Zona Incerta.
- Prof. Cesare Gagliardo described the technological evolution of MRgFUS systems and, relying on the long standing experience of the Palermo center, discussed the technical nuances behind the treatments. He was passionate about using MRgFUS to respond to patients’ requests for less invasive – yet safe – procedures that do not compromise clinical efficacy.
- Prof. Francesco Prada, a neurosurgeon at the C. Besta Institute in Milan, recently returned from a two-year fellowship at the Focused Ultrasound Foundation and discussed his preclinical research projects using a new approach with sonodynamic therapy to treat glioblastomas. He described this novel use for focused ultrasound to activate an imaging compound that destroys and shrinks glioblastomas. Because his results are promising, he hopes to translate sonodynamic therapy into a clinical study as soon as possible.
- Lastly, Suzanne LeBlang, MD, the Foundation’s Director of Clinical Relationships, described other emerging clinical applications of focused ultrasound, such as blood-brain barrier (BBB) opening with low-intensity focused ultrasound to deliver higher concentrations of chemotherapy agents and the potential of delivering immunotherapies. She also discussed the ability of focused ultrasound to induce neuromodulation in preclinical and clinical studies. She then summarized the role of the Focused Ultrasound Foundation and encouraged the attendees to apply to various programs supported by the Foundation.
The second day of the workshop began with an enthusiastic radiology resident from Palermo, Dr. Roberto Cannella, describing the role of MR and US contrast medium and the utility for BBB opening.
All five Italian sites presented various aspects of their MRgFUS programs including outcomes data, clinical experiences with functional neurosurgery, and the role of interdisciplinary teams for best patient care. The data mainly focused on their experiences with essential tremor and early experiences with tremor-dominant Parkinson’s disease.
- Dr. Carmelo Anfuso presented the first 10 patients treated in IRCCS Centro Neurolesi Bonino Pulejo in Messina with their recently installed equipment.
- Dr. Ludovico D’Incerti and Dr. Luigi Romito presented their experience at IRCSS Istituto Neurologico Carlo Besta in Milan, where 19 patients were treated. They also shared the potential of advanced MRI techniques in the preoperative planning for the treatment of movement disorders.
- Dr. Giuseppe Kenneth Ricciardi discussed imaging and promising results of 34 patients treated at the University of Verona for either essential tremor or tremor-dominant Parkinson’s disease.
- Dr. Frederico Bruno presented some of the most peculiar cases among the 58 patients with movement disorders treated in L’Aquila.
- Dr. Gagliardo reported the experience with the first tcMRgFUS system integrated into a 1.5T MR scanner, reviewed the results of 84 patients treated between 2015 and 2019 at the University of Palermo, and shared data regarding technical MRgFUS parameters that correlated with outcomes and the role of intraoperative imaging guidance.
Dr. Allegra Conti from Rome was the final presenter. She described her preclinical research entitled, “Low Intensity MRgFUS for Enhancing Radiosensitive Nanoparticle Uptake: Long Term Effects and Applications to a Preclinical Model for Glioblastoma” and reviewed the preclinical research trends related to focused ultrasound.
In summary, the workshop achieved several goals including sharing user experiences, strengthening the relationships among all teams for continued collaborations, and inspiring high levels of research with an enthusiastic commitment to exploring novel MRgFUS clinical applications.
Attendees discussed and advocated for a national registry of procedures to maximize best practices, establish standardized protocols, and improve patient outcomes.
In recognition and sincere appreciation for his distinguished dedication in the field of focused ultrasound, the Focused Ultrasound in Neuroscience: Italian Workshop and the Department of Biomedicine, Neurosciences, and Advanced Diagnostics at the University of Palermo presented Foundation Chairman Neal F. Kassell, MD, with a prestigious award. Dr. Kassell thanked the workshop and accepted the award on behalf of the Focused Ultrasound Foundation team via video.
The Foundation extends a special thanks to Roberto Cannella, MD, for providing details regarding the summary of the workshop.