More on Focused Ultrasound Surgery

Now that I have made the decision that I would prefer to have Focused Ultrasound Surgery (FUS) over Deep Brain Stimulation (DBS), I thought that I would give some more information on FUS and what it is that they do in this surgery.  I still don't know which surgery I will ultimately get approved for, if any.  However, they said that if there isn't a medical reason to prefer one surgery over the other then it would come down to patient preference.  As far as I know, there isn't a medical reason to prefer one surgery over the other, so I am hoping that I will be able to get FUS.

To begin, FUS isn't its full name.  It is more formally known as Magnetic Resonance-Guided Focused Ultrasound or MRgFUS.  That is because the entire surgery takes place inside an MRI machine.  They use the MRI images to guide them where to focus the ultrasound waves into the brain.  It is a painstaking procedure with the surgery lasting 3 to 4 hours or more.

I found the article "The History and Future of Ablative Neurosurgery for Major Depressive Disorder" to be extremely helpful.  It was written, in part, by three of the doctors that I am seeing at Sunnybrook Hospital regarding my surgery.  It discusses the surgeries that have historically been performed on people with depression and recent advances that may improve upon those surgeries.  MRgFUS is one of those advances.  In a MRgFUS surgery for depression they would perform an anterior cingulotomy using the ultrasound waves to create bilateral lesions in the anterior cingulate instead of using surgical tools.  As the article explains, this procedure has been used for decades and they expect a 50-60% success rate.  They don't know what the actual success rate will be though since they have only performed 5 of these MRgFUS surgeries for depression in North America (all at Sunnybrook Hospital) and only 20 in the world (with the rest being performed in South Korea).  They also don't know what the full range of possible side effects would be.  They do know that some people experience a headache, which goes away after a period of time, due to the device that they must bolt your head into.  They are also concerned that there may be some memory issues, for example, problems with short-term memory or verbal memory, although they haven't seen these to date.

One of the problems with proceeding with MRgFUS is that they may not be able to complete the procedure due to the density of the patient's skull.  The skull is made up of a layer of bone, and then a layer of marrow, and then another layer of bone, and finally the brain.  Sometimes the ultrasound waves will bounce off of the second layer of bone and not be able to reach the brain.  They can predict who this will happen to based upon the density of the skull using a CT scan ahead of time.  I was told that about 10% of people have skulls that will not permit MRgFUS.  If I am one of those people, then there is another option.  They can use Gamma Knife Radiation Surgery (GKRS) to perform the anterior cingulotomy using radiation to create the lesions instead of ultrasound waves.  This is not a preferred option since they don't have the image to guide them and it exposes the patient to radiation.  They said that a couple of people who couldn't have MRgFUS had to have this surgery performed and I would also go with GKRS if MRgFUS didn't work for me.

I was reminded recently of one of the reasons that I am considering such drastic measures to cure my depression.  I looked at an old picture from 2007 and I couldn't believe the way that I looked. 

I have not seen myself look so happy in years.  In 2007, my depression was just starting and I wasn't as affected by it as I have been over the past number of years.  That picture reminded me of what I have lost to my depression.  I have lost my happiness and joy of living.  I am a shell of my former self.  I would do anything to get that back.