high focused ultrasound

[Yoyomama88]

I was reading about ultrasound surgery used for tremors. If this ever becomes an FDA approved treatment, do you think neurologists could perform these procedures as they do with neurointerventional? Or would this likely be restricted to neurosurgeons? As neurosurgery becomes less and less invasive, will this allow neurology to become more procedural or will neurosurgery likely protect its turf?

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[Hank Rearden]

I'm guessing this would be restricted to Neurosurgeons. What would you do if there was a complication?

If you turn down the juice a little, you can actually stimulate a population of neurons about the size of a grain of rice. Unlike TMS, you can stimulate neurons very deep in the brain. I think there are still many safety hurdles yet to cross, but very cool technology.

 

[Yoyomama88]

what do neurologist trained interventionalists do when there is a complication with their procedures?

 

[typhoonegator]

It depends on the complication. Groin? Aorta? Brain? Spine? Ischemic or hemorrhagic? If you're trying to make the case that neuroIR can't manage their complications, then I could provide about 100 examples of that not being the case. They can handle routine complications, just like a general surgeon can handle routine complications of a laparotomy. Are there situations in which they might need help from vascular surgery, cardiothoracic surgery, vascular IR, or neurosurgery? Sure. But no one can do everything.

 

[oopsy]

There's no doubt, if there was one super-doctor who could coil an aneurysm and manage every possible complication, that'd be great. But I'd also expect him or her to repair the aorta they dissected, graft the iliac they busted, and manage all the ICU complications. Until that person exists, I'll stick to coordinated team care.

Whoever ends up with US ablation, all that matters is that they are technically (very) competent, astute enough to identify complications, and able to manage complications either by themselves or with other sub-specialists.

Otherwise, we'll need a lot more CT-surgeons to do all the thoracentesis that needs to get done today, a lot more general surgeons to do screening colonoscopies, and a lot more neurointensivists to do aneurysm clippings.

 

[Hank Rearden]

OK - easy bandwagoners. For the record, I'm pro Neurologist as Interventionalist. I suppose what I should have said is I personally would not feel comfortable performing this procedure. Then again, I've dealt with the aftermath of enough neuro-IR procedures gone awry that I probably wouldn't feel comfortable being a cath jockey either. I'm glad there are Neurologists who are interested in doing this.

 

[Yoyomama88]

So technically, there isn't anything that would stop a neurologist from performing this procedure if it were to become FDA approved? Or does it simply have to do with a hospital giving privileges to that physician?

 

[TUGM]

MRgFUS in a non-invasive procedure. I suppose if a neurologist became trained in its use for indications such as essential tremor/thalamotomy, then there would be no issues. I'm not really sure what specialty of physicians is conducting the research behind the technique and outcomes, but most likely that group will earn privileges. If us neurologists want in, we gotta go after it!

 

[Yoyomama88]

I believe neurosurgery is conducting the research. However, technically non-invasive brain surgery can be performed with a gamma knife and obviously this is not something done by neurologists...

 

[TUGM]

Well radio surgery was pioneered by Leskell, a neurosurgeon from Sweden and continued to be adapted and developed by several neurosurgeons across the globe. I think it has historically been a collaboration between neurosurgeons and radiation oncologists - from what I know, neurosurgeons place the frame, the rad-oncs operate and shoot the beams. Neurologists didn't seem to show much interest in performing procedures before, so they never acquired any turf. Potentially, a new breed of neuro-oncologists can participate in these procedures, though it is most likely completely institutionally dependent.

So I guess my point is, in the distant future (since you are apparently pre-health), if you have continued interest in this procedure and want to be a neurologist, you should take steps to contribute to the research and development of it. That way, when the time comes around to decide who gets to do it, you can say well I helped create it/enhance it/developed the protocols for it, then maybe you will be granted privileges. As of now, it seems like this technology is very new, and the future is quite uncertain.

 

[Yoyomama88]

What about TMS or TCDCS? I realize this is primarily used for depression, but do people think these non-invasive stimulation techniques will have a significant role in the future of neurology? If anything we understand more about neurological illness than psychiatric, so one would think neurology may be able to utilize this technology better than psychiatry?