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Operative Neurosurgery

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this.features)));n.length>0&&(0,e.R)(36,{targetFeature:r.featureName,missingDependencies:n}),this.features[r.featureName]=new r(this)}))}catch(t){(0,e.R)(22,t);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,R.Zm)();delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.features,delete this.sharedAggregator;return r.ee.get(this.agentIdentifier).abort(),!1}}}({features:[he,w,N,Ne,_e,_,D,ot,ct,je,nt],loaderType:"spa"})})()})();</script><meta charset="utf-8" /><meta name="viewport" content="width=device-width, initial-scale=1" /><meta http-equiv="Expires" content="0" /><meta name="DCSext.AbsHTMLview" content="1" /><meta name="WT.cg_n" content="onsonline" /><meta name="WT.cg_s" content="Articles" /><meta name="wkhealth_journal_title" content="Operative Neurosurgery" /><meta name="wkhealth_journal_title_legacy" content="Operative Neurosurgery" /><meta name="wkhealth_issue" content="1" /><meta name="wkhealth_article_publication_date" content="2019-12-19" /><meta name="wkhealth_volume" content="19" /><meta name="wkhealth_ovid_accession_number" content="01787389-202007000-00002" /><meta name="wkhealth_issn" content="2332-4252" /><meta name="wkhealth_title" content="Focused Ultrasound Strategies for Brain Tumor Therapy" /><meta name="wkhealth_authors" content="Bunevicius, Adomas;McDannold, Nathan Judson;Golby, Alexandra J" /><meta name="wkhealth_doi" content="10.1093/ons/opz374" /><meta name="wkhealth_abstract_html_url" content="https://journals.lww.com/onsonline/abstract/2020/07000/focused_ultrasound_strategies_for_brain_tumor.2.aspx" /><meta name="wkhealth_fulltext_html_url" content="https://journals.lww.com/onsonline/fulltext/2020/07000/focused_ultrasound_strategies_for_brain_tumor.2.aspx" /><meta name="wkhealth_toc_section" content="REVIEW" /><meta name="wkhealth_toc_sub_section" /><meta name="wkhealth_eJpId" content="onsonline:2020:07000:00002" /><meta name="wkhealth_firstpage" content="9" /><meta name="wkhealth_date" content="July 2020" /><meta name="wkhealth_pdf_url" content="https://journals.lww.com/onsonline/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=Other&amp;an=01787389-202007000-00002" /><meta name="Description" content="BACKGROUND A key challenge in the medical treatment of brain tumors is the limited penetration of" /><meta property="og:site_name" content="LWW" /><meta property="og:type" content="article" /><meta property="og:title" content="Focused Ultrasound Strategies for Brain Tumor Therapy : Operative Neurosurgery" /><meta property="og:description" content="tool to enhance the delivery of chemotherapeutic agents into brain tumors. OBJECTIVE To review the mechanism of FUS, preclinical evidence, and clinical studies that used low-frequency FUS for a BBB opening in gliomas. METHODS Literature review. RESULTS The potential of externally delivered low-intensity ultrasound for a temporally and spatially precise and predictable disruption of the BBB has been investigated for over a decade, yielding extensive preclinical literature demonstrating that FUS can disrupt the BBB in a spatially targeted and temporally reversible manner. Studies in animal models documented that FUS enhanced the delivery of numerous chemotherapeutic and investigational agents across the BBB and into brain tumors, including temozolomide, bevacizumab, 1,3-bis (2-chloroethyl)-1-nitrosourea, doxorubicin, viral vectors, and cells. Chemotherapeutic interventions combined with FUS slowed tumor progression and improved animal survival. Recent advances of MRgFUS systems allow precise, temporally and spatially controllable, and safe transcranial delivery of ultrasound energy. Initial clinical evidence in glioma patients has shown the efficacy of MRgFUS in disrupting the BBB, as demonstrated by an enhanced gadolinium penetration. CONCLUSION Thus far, a temporary disruption of the BBB followed by the administration of chemotherapy has been both feasible and safe. Further studies are needed to determine the actual drug delivery, including the drug distribution at a tissue-level scale, as well as effects on tumor growth and patient prognosis...." /><meta property="og:image" content="https://images.journals.lww.com/onsonline/SocialThumb.01787389-202007000-00002.fig1.jpeg" /><meta property="og:image:width" content="1772" /><meta property="og:image:height" content="1053" /><meta property="og:url" content="https://journals.lww.com/onsonline/fulltext/2020/07000/focused_ultrasound_strategies_for_brain_tumor.2.aspx" /><meta property="twitter:card" content="summary" /><meta name="robots" content="index, follow, noarchive" /><meta name="WT.sv" content="ZUSE1PEJPWEB03" /><meta name="Title" content="Operative Neurosurgery" /><style id="SPThemeHideForms" type="text/css">body {opacity:0 !important}</style> <!-- Head container delegate control --> <link 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Made in \u00A9 BioRender – <span xmlns:ssr=\"http://ssr-eus-go-csi.cloudapp.net/v1/assets\" xmlns:xlink=\"http://www.w3.org/1999/xlink\" xmlns:xhtml=\"http://www.w3.org/1999/xhtml\">&nbsp;\r\n <a href=\"http://www.biorender.com\" onclick=\"javascript:window.open(\'http://www.biorender.com\');return false\">biorender.com</a></span>.","https://images.journals.lww.com/onsonline/Rollover.01787389-202007000-00002.fig1.jpeg","https://images.journals.lww.com/onsonline/Gallery.01787389-202007000-00002.fig1.jpeg","https://journals.lww.com/onsonline/_layouts/oaks.journals/ImageView.aspx?k=onsonline:2020:07000:00002&i=fig1&year=2020&issue=07000&article=00002&type=Abstract&context=featuredarticles&collectionid=15","https://images.journals.lww.com/onsonline/Original.01787389-202007000-00002.fig1.jpeg","/onsonline/pages/imagegallery.aspx?year=2020&issue=07000&article=00002", "onsonline_2020_07000_00002_fig1");images["fig2"]=new image("fig2","fig3","fig1","FIGURE 2.","Focal BBB disruption in the rabbit brain using FUS. Left panel, Localized extravasation of Magnevist (MRI contrast agent) in areas of blood-barrier disruption as seen on contrast enhanced T1-weighted brain MRI. Right panel, Change in contrast enhancement over time in the 4 sonicated brain regions and in nonsonicated (control) brain region. Reprinted with permission from Jolesz FA, McDannold N. Current status and future potential of MRI‐guided focused ultrasound surgery. Journal of Magnetic Resonance Imaging. 2008;27(2):9. (c) 2008 Wiley-Liss, Inc.","https://images.journals.lww.com/onsonline/Rollover.01787389-202007000-00002.fig2.jpeg","https://images.journals.lww.com/onsonline/Gallery.01787389-202007000-00002.fig2.jpeg","https://journals.lww.com/onsonline/_layouts/oaks.journals/ImageView.aspx?k=onsonline:2020:07000:00002&i=fig2&year=2020&issue=07000&article=00002&type=Abstract&context=featuredarticles&collectionid=15","https://images.journals.lww.com/onsonline/Original.01787389-202007000-00002.fig2.jpeg","/onsonline/pages/imagegallery.aspx?year=2020&issue=07000&article=00002", "onsonline_2020_07000_00002_fig2");images["fig3"]=new image("fig3","","fig2","FIGURE 3.","T1-weighted gadolinium-enhanced axial brain MRI immediately after BBB disruption with MRgFUS that demonstrates contrast extravasation in a discrete and precise grid pattern (enlarged panel) in regions where sonication was performed. Figure is reprinted from Mainprize T, et al (2019). Blood-Brain Barrier Opening in Primary Brain Tumors with Non-invasive MR-Guided Focused Ultrasound: A Clinical Safety and Feasibility Study. Scientific Reports, 9(1), 321. <span xmlns:ssr=\"http://ssr-eus-go-csi.cloudapp.net/v1/assets\" xmlns:xlink=\"http://www.w3.org/1999/xlink\" xmlns:xhtml=\"http://www.w3.org/1999/xhtml\">&nbsp;\r\n <a href=\"https://doi.org/10.1038/s41598-018-36340-0\" onclick=\"javascript:window.open(\'https://doi.org/10.1038/s41598-018-36340-0\');return false\">https://doi.org/10.1038/s41598-018-36340-0</a></span>. 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dib"> <a id="ctl00_ctl51_Header_UserActionTools_lnkSubscribe" class="user-menu__link" href="https://shop.lww.com/p/2332-4252" target="_blank"><i class="fa fa-bars"></i> <span class="hideOnFixed">Subscribe to journal</span><span class="showOnFixed">Subscribe</span></a> </li> <li id="ctl00_ctl51_Header_UserActionTools_liIssueAlerts" class="user-menu__item dib"> <i class="fa fa-envelope"></i> <a rel="nofollow" title href="javascript:javascript: alerts_ShowSubscribeeTOCPopup(&#39;Operative Neurosurgery&#39;,&#39;onsonline&#39;,&#39;eTOC&#39;, &#39;eTOC&#39;);;" onclick="javascript: alerts_ShowSubscribeeTOCPopup(&#39;Operative Neurosurgery&#39;,&#39;onsonline&#39;,&#39;eTOC&#39;, &#39;eTOC&#39;);" class="user-menu__link"><span id="ctl00_ctl51_Header_UserActionTools_SubscribeToAlertsActionToolLink_defaultText" class="hideOnFixed">Get new issue alerts</span><span id="ctl00_ctl51_Header_UserActionTools_SubscribeToAlertsActionToolLink_stickyText" class="showOnFixed">Get alerts</span></a> </li> </ul> </section> <span id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_dummyTargetControl"></span> <div id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pnlunSubscribeToAlerts" style="display: none;"> <div tabindex="-1" role="dialog" class="wk-modal horizontally-centered small wk-modal-with-overlay wk-modal-small ejp-modal"> <div id="ej-box-modal-style-1"> <div id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pnlMain"> <div id="tocUnsubscribeModal" > <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <p> <span id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage"></span> </p> <div class="wk-button-bar"> <div class="wk-button-group-left"> <p id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons" Style="display: none;"> <input type="submit" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$btnContinue" value="Yes" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions(&quot;ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$btnContinue&quot;, &quot;&quot;, true, &quot;&quot;, &quot;&quot;, false, false))" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_btnContinue" class="primary-button" /> <input type="button" value="No" id="btnCancel" aria-label="close dialog" class="js-close secondary-button" /> </p> </div> </div> </div> </div> </section> </div> </div> </div> </div> </div> <div id="ej-clear-float"> </div> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenUnSubscribeAlertType" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenUnsubscribeJournalId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenUnsubscribeMessage" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenTopicalCollectionId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenTopicalCollectionId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenOvidId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenOvidId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenJournalId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId" /> <script type="text/javascript"> function alerts_ShowUnSubscribeeTOCPopup(title, alertType, journalId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = alertType; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == null || document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == '') { document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value = journalId; } if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Root(title, journalId, alertType) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = alertType; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Citation(title, journalId, ovidId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = 'Citation'; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenOvidId').value = ovidId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Topical(title, journalId, topicalCollectionId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = 'Topical'; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenTopicalCollectionId').value = topicalCollectionId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == null || document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == '') { document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value = journalId; } if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCSuccessPopup() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } $('.js-close').on('click', function() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.hide(); } return false; }); </script> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_dummyTargetControl"></span> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenSubscribeToEtocPopupState" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState" value="showemail" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenConfirmSubscriptionPageUrl" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenJournalId" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenSubscriptionType" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType" /> <div id="divPopupOverLay" class="Popup-Overlay" style="display: none; position: fixed; left: 0; top: 0; z-index: 3800; width: 1920px; height: 4517px;"></div> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlSubscribeToEtoc" class="etoc-popup ej-box-modal-drop-shadow" style="display: none;"> <div tabindex="-1" role="dialog" class="wk-modal horizontally-centered small wk-modal-with-overlay wk-modal-small ejp-modal"> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlMain" onkeypress="javascript:return WebForm_FireDefaultButton(event, &#39;ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_btnContinue&#39;)"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblTitle"></span> </div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "> <i class="fa fa-times"></i> </button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <div class="wk-field-body"> <strong> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblThankYouMessage"></span></strong> </div> <div class="wk-field-body"> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError" style="color:Black;display:none;"> <div class="ej-error-message"> <p class="ej-error-message-icon error-red"> </p> </div> </span> <label for="Email input">Enter your Email address:</label> <div class="wk-field-body"> <input name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$txtEmailAddress" type="text" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress" class="ej-box-modal-style-1-input" /> </div> </div> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="submit" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$btnContinue" value="Continue" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions(&quot;ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$btnContinue&quot;, &quot;&quot;, true, &quot;&quot;, &quot;&quot;, false, false))" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_btnContinue" class="primary-button" /> <input type="button" value="Cancel" id="btnCancel" class="js-close secondary-button" /> </div> </div> </div> <div class="wk-field-item"> <div class="wk-field-body"> <a id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hypPrivacy" href="https://journals.lww.com/onsonline/_layouts/oaks.journals/privacy.aspx" target="_blank">Privacy Policy</a> </div> </div> </div> </section> </div> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser" style="display: none;"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <p> <strong> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle"></span> </strong> </p> </div> <p id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pAuthenticatedUserMessage"> </p> </div> </section> </div> </div> </div> <div id="ej-clear-float"> </div> <script type="text/javascript"> function alerts_SaveSubscriptionTypeInHiddenField(url, subscriptionType, journalId, yearId, issueId, articleId) { if (journalId && yearId && issueId && articleId) { logCounterDataAlertWhenCitedSynchronously(journalId, yearId, issueId, articleId); } $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType').val(subscriptionType); $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId').val(journalId); if (url) window.location = url; else __doPostBack('hypSubscribeToAlerts'); return false; } function alerts_ShowSubscribeeTOCPopup(journalTitle, journalId, subscriptionType, displaySubscriptionType) { $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType').val(subscriptionType); var subscribeToEtocPopup = $find('subscribeToEtoc'); subscribeToEtocPopup.show(); document.getElementsByTagName( 'html' )[0].classList.add('no-scroll'); var modelPopupState = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState'); var emailTextBox = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress'); var thanksPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser'); var mainPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlMain'); var thankYouMessageUnAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblThankYouMessage'); var thankYouMessageAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle'); if (!displaySubscriptionType) { displaySubscriptionType = subscriptionType; } if (modelPopupState.value == 'showthanksmessage') { thanksPanel.style.display = "block"; mainPanel.style.display = "none"; thankYouMessageAuthenticated.innerHTML = "Thank you for subscribing to the " + displaySubscriptionType + " for " + journalTitle + "."; } if (modelPopupState.value == 'showemail') { thanksPanel.style.display = "none"; mainPanel.style.display = "block"; thankYouMessageUnAuthenticated.innerHTML = "Thank you for choosing to subscribe to the " + displaySubscriptionType + " for " + journalTitle + "."; } if ($('.etoc-popup') != null) { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId').value = journalId; if (modelPopupState.value == 'showemail') emailTextBox.focus(); } } $('.js-close').on('click', function () { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress').value = ""; document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError').style.display = "none"; var pageUrl = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl'); var subscribeeTocPopup = $find('subscribeToEtoc'); if (subscribeeTocPopup != null) { subscribeeTocPopup.hide(); document.getElementsByTagName( 'html' )[0].classList.remove('no-scroll'); if (pageUrl.value !== '' && pageUrl.value !== window.location.pathname) window.location = pageUrl.value; } return false; }); </script> <div id="ctl00_ctl51_Header_UserActionTools_eTocTopContainer"> <div id="eTocTop" style="display: none;"> <a rel="nofollow" title href="javascript:javascript: alerts_ShowSubscribeeTOCPopup(&#39;Operative Neurosurgery&#39;,&#39;onsonline&#39;,&#39;eTOC&#39;, &#39;eTOC&#39;);;" onclick="javascript: alerts_ShowSubscribeeTOCPopup(&#39;Operative Neurosurgery&#39;,&#39;onsonline&#39;,&#39;eTOC&#39;, &#39;eTOC&#39;);"><span id="ctl00_ctl51_Header_UserActionTools_alertLinkControlTop_defaultText" class="hideOnFixed">Subscribe to eTOC</span></a> </div> </div> <script> $(function () { //find recent searches link and move container var recentSearchesControl = $("a[id$='RecentSearches']"); if (recentSearchesControl.length) { recentSearchesControl.click(function (e) { e.stopPropagation(); if ($("#ResentSearchContainer").is(":hidden")) { $("#ResentSearchContainer").slideDown("slow"); recentSearchesControl.addClass('open'); } else { $("#ResentSearchContainer").hide(); recentSearchesControl.removeClass('open'); } }); } var eTocAccountLink = $("ul.js-user-action-toolbar__dropdown>li>a[id='SubscribeToEToc']"); if (eTocAccountLink.length) { eTocAccountLink.parent().html($("#eTocTop>a")); } }); </script> <a class="logo-secondary white" href="http://wolterskluwer.com/" target="_blank"> <h3 class="logo-secondary-text">Secondary Logo</h3> </a> <a href="#" class="sticky-search"><i class="fa fa-search"></i></a> </div> <div class="header__layout-bottom wk-grid-page-container"> <a id="hypJournals" class="logo-main" href="https://journals.lww.com/onsonline/pages/default.aspx"> <h3 class="logo-main-text">Journal Logo </h3> </a> <div class="search-v2"> <div class="search-wrapper"> <select name="ctl00$ctl51$Header$SearchTopBoxControl$ddlContentScope" id="ctl00_ctl51_Header_SearchTopBoxControl_ddlContentScope"> <option value="All">All</option> <option selected="selected" value="Articles">Articles</option> <option value="Images">Images</option> <option value="Videos">Videos</option> <option value="Podcasts">Podcasts</option> <option value="Blogs">Blogs</option> </select> <div class="input-group" id="globalSearch"> <input name="ctl00$ctl51$Header$SearchTopBoxControl$txtKeywords" type="text" value="Search" id="ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords" class="form-control searchText" /> <span class="input-group-btn"> <button id="ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearchMagnifier" type="submit" class="btn btn-default"><i class="fa fa-search"></i></button> </span> <input type="hidden" name="ctl00$ctl51$Header$SearchTopBoxControl$IsAutoCompleteEnabled" id="ctl00_ctl51_Header_SearchTopBoxControl_IsAutoCompleteEnabled" value="false" /> <input type="hidden" name="ctl00$ctl51$Header$SearchTopBoxControl$AutocompleteApiUrl" id="ctl00_ctl51_Header_SearchTopBoxControl_AutocompleteApiUrl" value="https://platformservices.wolterskluwerhealth.com/autocomplete/oneus/shingle/" /> </div> </div> <div class="advance-search" style=""> <a id="ctl00_ctl51_Header_SearchTopBoxControl_lnkAdvanceSearch" href="https://journals.lww.com/onsonline/pages/advancedsearch.aspx">Advanced Search</a> <input type="submit" name="ctl00$ctl51$Header$SearchTopBoxControl$btnGlobalSearch" value="" id="ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch" disabled="disabled" class="aspNetDisabled btnGlobalSearch" style="display: none;" /> <input name="ctl00$ctl51$Header$SearchTopBoxControl$hfldKeywords" type="hidden" id="ctl00_ctl51_Header_SearchTopBoxControl_hfldKeywords" class="hfldKeywords" value="disableButton" /> </div> </div> <script> $(function() { try { var objSearchBox = { btnGlobalSearchMagnifierId: 'ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearchMagnifier', searchButtonId: 'ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch', txtKeywordsId: 'ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords', hfldKeywordsHiddenId: 'ctl00_ctl51_Header_SearchTopBoxControl_hfldKeywords', defaultSearchText: 'Search' }; new Searchbox(objSearchBox).Init(); } catch (e) { console.error(e); } }); //autocomplete functionality for basic search //this functionality will call the SBA url and start suggesting after typing 3rd character var textKeywords = null; var hiddenAutocompleteApiUrl = null; var buttonGlobalSearch = null; $(function () { try { var objAutocomplete = { hiddenIsAutoCompleteEnabled: $('#ctl00_ctl51_Header_SearchTopBoxControl_IsAutoCompleteEnabled'), textKeywords: $('#ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords'), hiddenAutocompleteApiUrl: $('#ctl00_ctl51_Header_SearchTopBoxControl_AutocompleteApiUrl'), buttonGlobalSearch: $('#ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch'), enableNewAutoComplete: true, newAutoCompleteUrl: 'https://dxg-search-na-prd.wkgposvc.cloud/Query.svc/Query_Expand', newAutoCompleteMaxSuggestions: '10', newAutoCompleteDictionaryIds: 'ovid_sted28_mesh22' }; autoComplete(objAutocomplete); } catch (e) { console.error(e); } }); $(function () { let searchSelect = $('select[id$="ddlContentScope"]');; if (searchSelect.length){ searchSelect.selectize(); } }); </script> </div> <div id="main-nav-container-v2"> <nav id="main-nav" class="navbar navbar-default yamm wk-grid-page-container"> <div class="navbar-header"> <button id="fatJuicy" type="button" class="navbar-hamburger-button 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Ultrasound Strategies for Brain Tumor Therapy', '12192019', 'Adomas Bunevicius, Nathan Judson McDannold, and Alexandra J Golby', '19', '1', 'Copyright \u00A9 2019 by the Congress of Neurological Surgeons', '01787389-202007000-00002', '', false, ''); } </script> <div id="ArticleContainer"> <article id="ej-abstract-view" xmlns:ssr="http://ssr-eus-go-csi.cloudapp.net/v1/assets" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xhtml="http://www.w3.org/1999/xhtml"><section class="ejp-r-article-subsection"><div class="ejp-r-article-subsection__text">REVIEW</div></section><header class="ejp-article-header"><h1 class="ejp-article-title">Focused Ultrasound Strategies for Brain Tumor Therapy</h1></header><section id="ejp-article-authors"><p id="P7"><i class="wki icon-orcid" onclick="javascript:ToolTip_Orcid('Bunevicius, Adomas MD, PhD', 'http://orcid.org/0000-0003-0446-6898');" onmouseover="javascript:ToolTip_Orcid('Bunevicius, Adomas MD, PhD', 'http://orcid.org/0000-0003-0446-6898');"></i>Bunevicius, Adomas MD, PhD; McDannold, Nathan Judson PhD; <i class="wki icon-orcid" onclick="javascript:ToolTip_Orcid('Golby, Alexandra J MD', 'http://orcid.org/0000-0001-8461-9561');" onmouseover="javascript:ToolTip_Orcid('Golby, Alexandra J MD', 'http://orcid.org/0000-0001-8461-9561');"></i>Golby, Alexandra J MD</p><section><a href="#" id="ejp-article-authors-link"> Author Information <i class="wk-icon-arrow-down-r"></i></a></section></section><section id="ejp-article-authors-info" class="ejp-article-authors-info ejp-article-authors-info--hidden"><div class="ejp-article-authors-info-holder"> <p id="">Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts</p> <p id="">Harvard Medical School, Harvard University, Boston, Massachusetts</p> <p id="">Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts</p> <p id="cor1"><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Correspondence:</strong> Alexandra J. Golby, MD, Department of Neurosurgery, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. Email: <span><a href="/cdn-cgi/l/email-protection#177a767e7b63782d7670787b756e5775607f397f76656176657339727362" onclick="javascript:window.open('mailto:mailto:agolby@bwh.harvard.edu');return false"><span class="__cf_email__" data-cfemail="1e7f7971727c675e7c697630767f6c687f6c7a307b7a6b">[email&#160;protected]</span></a></span></p> </div></section><section id="article-journal-info"><div class="ej-journal-info"><span class="ej-journal-name">Operative Neurosurgery </span><span id="ej-journal-date-volume-issue-pg"><a href="/onsonline/toc/2020/07000">19(1):p 9-18, July 2020.</a></span><span> | </span><span class="ej-journal-doi">DOI: </span>10.1093/ons/opz374</div></section><section id="ejp-article-indicators" class="ejp-article-indicators"><ul class="ejp-article-indicators__list"> <li id="ej-article-indicators-buy" class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_Buy()" onmouseout="javascript:Tooltip_MouseOut()"><a href="#ContentAccessOptions"><span class="ejp-indicator">Buy</span></a></li> <li class="ejp-article-indicators__list-item"><span class="ejp-indicator">EDITOR'S CHOICE</span></li> </ul><button id="openArticleMetricsPopupButton" type="button" class="wk-button wk-button-ghost wk-button-icon-left ejp-article-metrics-btn" data-articleMetricsEndpoint="//services.journals.lww.com/IntegrationServices/ArticleMetricsService.svc" data-articleMetricsDetailsUrl="https://wolterskluwer.altmetric.com/details/" data-doi="10.1093/ons/opz374" data-suiteId="vrs_woltere_journalsglobalvrs" data-articlePublicationDate="2019-12-19" data-articlePublicationDateString="2019-12-19" data-receivedDate="2019-07-24" data-revisionReceivedDate="" data-acceptedDate="2019-09-20" data-crossrefRefLinkRoot="https://doi.org/" data-medlineRefLinkRoot="http://www.ncbi.nlm.nih.gov/pubmed/" data-pubMedId=""><i class="wk-icon-filled-chart-r"></i><i class="wk-icon-filled-chart-white-r"></i> Metrics </button></section><section class="ejp-article-tabs" id="abstractWrap"><h2 class="ejp-article-tabs-heading">Abstract</h2> <div class="ejp-article-tabs__tabpanel" id="panel1" role="tabpanel" aria-labelledby="tab1"> <div id="article-abstract-content1"> <div class="ejp-article-text-abstract"> <h3>BACKGROUND&nbsp;</h3> <p>A key challenge in the medical treatment of brain tumors is the limited penetration of most chemotherapeutic agents across the blood–brain barrier (BBB) into the tumor and the infiltrative margin around the tumor. Magnetic resonance-guided focused ultrasound (MRgFUS) is a promising tool to enhance the delivery of chemotherapeutic agents into brain tumors.</p> <h3>OBJECTIVE&nbsp;</h3> <p>To review the mechanism of FUS, preclinical evidence, and clinical studies that used low-frequency FUS for a BBB opening in gliomas.</p> <h3>METHODS&nbsp;</h3> <p>Literature review.</p> <h3>RESULTS&nbsp;</h3> <p>The potential of externally delivered low-intensity ultrasound for a temporally and spatially precise and predictable disruption of the BBB has been investigated for over a decade, yielding extensive preclinical literature demonstrating that FUS can disrupt the BBB in a spatially targeted and temporally reversible manner. Studies in animal models documented that FUS enhanced the delivery of numerous chemotherapeutic and investigational agents across the BBB and into brain tumors, including temozolomide, bevacizumab, 1,3-bis (2-chloroethyl)-1-nitrosourea, doxorubicin, viral vectors, and cells. Chemotherapeutic interventions combined with FUS slowed tumor progression and improved animal survival. Recent advances of MRgFUS systems allow precise, temporally and spatially controllable, and safe transcranial delivery of ultrasound energy. Initial clinical evidence in glioma patients has shown the efficacy of MRgFUS in disrupting the BBB, as demonstrated by an enhanced gadolinium penetration.</p> <h3>CONCLUSION&nbsp;</h3> <p>Thus far, a temporary disruption of the BBB followed by the administration of chemotherapy has been both feasible and safe. Further studies are needed to determine the actual drug delivery, including the drug distribution at a tissue-level scale, as well as effects on tumor growth and patient prognosis.</p> </div> </div> </div></section><section class="ej-article-copyright">Copyright © 2019 by the Congress of Neurological Surgeons</section></article> </div> </div> <section id="ContentAccessOptions" class="article-not-authorized-msg"> <div class="ejp-access-options-wrapper"> <div class="ejp-access-options ejp-access-options--desktop"> <div id="ctl00_ctl29_g_9d8d8345_79ae_4158_b5f4_0e00a33d4d27_ctl00_FullTextAccessOptionsContainer" class="ejp-access-options__subscriber-access"> <h3 class="ejp-access-options__subscriber-access-title">Full Text Access for Subscribers:</h3> <div class="ejp-access-options__subscriber-access-society-list"> <div id="ctl00_ctl29_g_9d8d8345_79ae_4158_b5f4_0e00a33d4d27_ctl00_PrimaryLoginBox" class="box-ssologin primary-login-box"> <a 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class="wk-modal-slideshow__title"></div> </h3> <div class="wk-modal-slideshow__description"></div> <h4>Source</h4> <div class="wk-modal-slideshow__source-article mb4"> <a href="javascript:void(0);" id="ctl00_ctl29_g_9d8d8345_79ae_4158_b5f4_0e00a33d4d27_ctl00_slideShowUserControl_sourceArticleUrl" onclick="HideSlideShow();">Focused Ultrasound Strategies for Brain Tumor Therapy</a> </div> <div id="ctl00_ctl29_g_9d8d8345_79ae_4158_b5f4_0e00a33d4d27_ctl00_slideShowUserControl_citationdiv" class="wk-modal-slideshow__source-citation mb4"> Operative Neurosurgery19(1):9-18, July 2020. </div> </div> </div> <div class="modal-footer wk-modal-footer wk-modal-slideshow__footer pa2 flex flex-column flex-wrap"> <div class="wk-modal-slideshow__zoom-controls flex justify-between items-center mb2"> <div id="zoom_buttons" class="wk-modal-slideshow__zoom-buttons flex justify-between"> <a href="#" onmousedown="$('#zoom_container').z('zoomIn')" onclick="return false" title="Zoom In" class="ph3"><i class="fa 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