MRI-guided focused ultrasound promises a fundamental shift in neurosurgery: no incision, no anesthesia, and immediate assessment of effect. Insite Tech, founded in 1998 in Haifa and now operating globally, shows that procedures for movement disorders can be performed precisely and safely. The lecture by Alexandra Pesca presented the technology, the evidence, and why a “pioneering” solution is becoming standard practice.
Ultrasound instead of a scalpel
The basis is focused ultrasound that, under magnetic resonance guidance, converges on a target point in the brain. Computer algorithms enable sub-millimeter targeting, and clinicians can see what they are doing in real time—including immediate assessment of effect and possible adverse effects. The technology is intended primarily for movement disorders, and has CE and FDA approvals for essential tremor, Parkinson's disease, and neuropathic pain; for essential tremor it covers both unilateral and bilateral solutions. Crucially, it is not a craniotomy: no sterile operating room is required, no incision is made, the patient receives neither sedation nor anesthesia, and the result is visible immediately.
How the procedure works
The patient wears a special “helmet-like” applicator in the MR environment, and the ultrasound energy converges precisely into a small focal spot in the brain. Clinicians first localize the target anatomically and, at lower temperatures, observe the response to confirm the correct location; only then do they raise the temperature to a level that induces permanent ablation and coagulation. The entire procedure takes about two hours, without incision, without sedation, and without anesthesia, with continuous imaging and thermal feedback. The first effects, such as tremor reduction, can be observed during the procedure itself, bringing patients immediate relief.
Evidence, availability, and an open opportunity
According to the data presented, there are already about 72 active sites worldwide, with dozens of centers in Europe and Asia; the growth rate is underscored by thousands of patients treated just this year. Crucially, the technology has broad reimbursement, which accelerated adoption—an example is a country where early uptake by leading clinicians and swift reimbursement delivered the most centers per capita. The platform is compatible with multiple MR systems, and compatibility with Philips is expected over the course of next year; the company does not only sell a device, but provides a partnership from planning through installation to clinical support, including the presence of application specialists for the first dozens of patients.
In terms of evidence, a five-year study has been published showing stable efficacy and a low incidence of adverse events; meta-analyses and cohort studies are also available. German professional societies label this method as mainstream for essential tremor and Parkinson's disease, and further clinical trials are underway. The need is enormous: it concerns tens of millions of people worldwide, many of whom remain without adequate treatment, with impacts on work, social life, and the costs of care. As stated in conclusion: let us not ask how much it costs to treat a patient, but how much it costs not to treat them.
