Nonablative Brain Surgery Treats Neurological Diseases

Low-intensity MR-guided focused ultrasound (MRgFUS), combined with intravenous microbubbles, can help deliver targeted neurotoxin therapy, according to a study.

The new technique, called PING, was developed by researchers at the University of Virginia (UVA; Charlottesville, USA), Stanford University (CA, USA), and other institutions. It is designed to destroy neurons in the brain parenchyma by opening up the blood-brain barrier (BBB) in a transient and focal manner in order to deliver a systemically administered neurotoxin (quinolinic acid) that is well tolerated peripherally and otherwise impermeable to the BBB.


In two research models of epilepsy in rats, the researchers found that PING can reduce or eliminate the seizures. Focal neuronal loss was observed in the targeted areas of BBB opening, including brain regions that are prime objectives for epilepsy surgery. Notably, they found that other structures in the area of neuronal loss, including axons of passage, glial cells, vasculature, and the ventricular wall, were spared with this procedure. The study was published on November 19, 2021, in the Journal of Neurosurgery.

“This novel surgical strategy has the potential to supplant existing neurosurgical procedures used for the treatment of neurological disorders that don't respond to medication. This unique approach eliminates the diseased brain cells, spares adjacent healthy cells, and achieves these outcomes without even having to cut into the scalp,” said lead author Kevin Lee, PhD, of the UVA Departments of Neuroscience and Neurosurgery and the Center for Brain Immunology and Glia (BIG). “Our hope is that PING strategy will become a key element in the next generation of very precise, noninvasive, neurosurgical approaches to treat major neurological disorders.”

The BBB is comprised of specialized endothelial cells that form the capillary microvasculature of the central nervous system (CNS), and is essential for brain function. It selectively prevents substances from entering the blood and brain, only allowing such essential molecules as amino acids, oxygen, glucose and water through. But on the other hand, it also poses the greatest impediment in the treatment of many CNS diseases because it commonly blocks entry of therapeutic compounds.

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