Before Treatment
Once you have been evaluated as a suitable candidate, there may be a CT scan scheduled in order to determine if the shape and thickness of your skull are suitable for the Exablate Neuro device. Your entire scalp will be shaved and cleaned. A urinary catheter will be placed in order to drain your bladder during the procedure, and you will likely wear some form of compression stockings during the procedure. You may need to start taking medication to minimize risks of DVT (a blood clot). You will be administered medications for comfort. Most doctors use conscious sedation, which means you are awake during the procedure, but you may feel groggy; you and your doctor will decide which type of sedation is best for you. A stereotactic frame will be attached to your head to prevent any movement of the skull during sonications. A silicon helmet will be placed around the head to allow cool water to circulate, minimizing potential heating near the scalp. Your heart rate, blood pressure and blood oxygen levels will be monitored throughout the procedure.
During the Treatment
You will be moved inside the MR device and will be given a Stop Sonication Button to hold during the procedure. The procedure will be performed from a computer in the room adjoining the MR suite. A series of MR images are taken for the purpose of planning the treatment. Your physician will mark the area to be treated, and low energy sonications will be administered to elicit physiological responses from you in order to ensure they have located the proper spot in the brain.
After each sonication, a neurologist or neurosurgeon will evaluate feedback and given tasks in order to determine the effect of the sonication on the tremor itself. You must remain still throughout the treatment session. The procedure may last anywhere from 1 to 3 hours, depending on the amount of energy that can be focused during each sonication. The time is dependent on many factors associated with the shape and thickness of the your skull.
After Treatment
You will be removed from the MR machine, and the stereotactic frame will be removed. Once you are stable, all the monitoring equipment and catheters will be removed. You will have a final 20-minute MRI scan without a frame and then rest as prescribed by your physician.
You will receive specific discharge instructions from your doctor. Usually nothing is required, although your doctor may recommend over-the-counter pain relief medication. Most patients are able to return to work and normal activities within days.
It is important that you discuss with your doctor ahead of time who will handle your follow-up care. Be sure to arrange follow-up phone calls and/or office visits for after the procedure. You should also know who to contact in case of an emergency after the procedure.