(AS1) Hemorrhagic Safety of Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Essential Tremor Without Interruption of Antiplatelet or Anticoagulant Therapy

Introduction: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an incisionless ablative technique used to treat medically refractory essential tremor (ET). Although the MRgFUS thalamotomy literature has not reported intracerebral hemorrhage, clinicians commonly discontinue active antiplatelet and anticoagulant (AP/AC) medications before the procedure and resume them after. However, bleeding risk is likely minimal given the mechanism of action of MRgFUS is focal thermoablation. We aimed to retrospectively evaluate hemorrhagic complications in patients that did not cease AP/AC therapies prior to MRgFUS thalamotomy.

Methods: This was a single-center case series of all patients with ET undergoing MRgFUS from 02/2019-05/2022 (n = 73). Demographic variables and medications taken at the time of surgery were obtained through chart review. The primary outcome was the type and frequency of complications noted on the operative report or postoperative imaging. Patients were grouped into two categories depending on whether they were actively taking AP/AC therapies or not. A two-sided z-test was used to evaluate whether complications occurred disproportionately between the groups.

Results: The mean age of patients was 74.4 years, and 23.3% were female. Thirty patients took ≥1 AP/AC medications before, during, and after the procedure without interruption. No hemorrhagic complications occurred in the group actively taking AP/AC therapies. There was no increased risk in the patients taking AP/AC medication (p < 0.00001).

Conclusion : The proportion of intra- or postoperative complications from MRgFUS was not any different in patients actively taking AP/AC therapies relative to those who were not. Our findings suggest that MRgFUS thalamotomy does not necessitate interruption of AP/AC therapies. However, given the limited number of patients actively taking these medications in our cohort (n = 30), further testing in large, prospective studies should be conducted to establish safety. We also plan to include additional outcome metrics and more patients in our future analysis.