In vivo transcranial brain surgery with an ultrasonic time reversal mirror

<jats:sec> <jats:title>Object</jats:title> <jats:p>High-intensity focused ultrasonography is known to induce controlled and selective noninvasive destruction of tissues by focusing ultrasonic beams within organs, like a magnifying glass concentrating enough sunlight to burn a hole in paper. Such a technique should be highly interesting for the treatment of deep-seated lesions in the brain. Nevertheless, ultrasonic tissue ablation in the brain has long been hampered by the defocusing effect of the skull bone.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In this in vivo study, the authors used a high-power time-reversal mirror specially designed for noninvasive ultrasonic brain treatment to induce thermal lesions through the skulls of 10 sheep. The sheep were divided into three groups and, depending on group, were killed 1, 2, or 3 weeks after treatment. The thermal lesions were confirmed based on findings of posttreatment magnetic resonance imaging and histological examinations.</jats:p> <jats:p>After treatment, the basic neurological functions of the animals were unchanged: the animals recovered from anesthesia without any abnormal delay and did not exhibit signs of paralysis or coma. No major behavioral change was observed.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The results provide striking evidence that noninvasive ultrasonographic brain surgery is feasible. Thus the authors offer a novel noninvasive method of performing local brain ablation in animals for behavioral studies. This technique may lead the way to noninvasive and nonionizing treatment of brain tumors and neurological disorders by selectively targeting intracranial lesions. Nevertheless, sheep do not represent a good functional model and extensive work will need to be conducted preferably on monkeys to investigate the effects of this treatment.</jats:p></jats:sec>