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Essential Tremor: Lesions

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Stereotactic and Functional Neurosurgery

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Abstract

The treatment of medication-refractory tremor with cerebral lesioning has significantly evolved since its inception in the 1930s. While originally a highly morbid procedure, innovations in stereotactic localization and image guidance have led to several safe and efficacious methods for the surgical treatment of essential tremor. Current targets include the ventral intermediate nucleus of the thalamus and posterior subthalamic area. Radiofrequency ablation, Gamma Knife radiosurgery, and magnetic resonance-guided focused ultrasound are modern lesioning modalities in the treatment of essential tremor, and individual patient characteristics and expectations are taken into account when choosing a particular technique. The irreversibility of cerebral lesioning in the setting of current neuromodulation technology has reduced its enthusiasm; but recent advancements in transcranial procedures, patient-specific targeting, and image guidance are reinvigorating lesioning as a surgical option for tremor.

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Abbreviations

AAN:

American Academy of Neurology

AC:

Anterior commissure

AChA:

Anterior choroidal artery

ADC:

Apparent diffusion coefficient

ADL:

Activities of daily living

CRST:

Clinical Rating Scale for Tremor

CSF:

Cerebrospinal fluid

CT:

Computed tomography

DBS:

Deep brain stimulation

DRT:

Dentatorubrothalamic tract

DWI:

Diffusion-weighted imaging

GK:

Gamma Knife

GKRS:

Gamma Knife radiosurgery

ICL:

Intercommissural line

MCP:

Midcommissural point

MER:

Microelectrode recording

MPR:

MP-RAGE

MRgFUS:

Magnetic resonance-guided focused ultrasound

MRI:

Magnetic resonance imaging

PC:

Posterior commissure

PD:

Parkinson’s disease

PSA:

Posterior subthalamic area

RF:

Radiofrequency

SDR:

Skull density ratio

SWI:

Susceptibility-weighted imaging

Vc:

Ventralis caudalis

Vim:

Ventral intermediate

VL:

Ventrolateral

Vop:

Ventralis oralis posterior

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Shayan Moosa

  2. Departments of Neurological Surgery and Neurology, University of Virginia, Charlottesville, VA, USA

    W. Jeffrey Elias

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  1. Shayan Moosa
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Correspondence to W. Jeffrey Elias .

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Editors and Affiliations

  1. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Nader Pouratian

  2. Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA

    Sameer A. Sheth

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Moosa, S., Elias, W.J. (2020). Essential Tremor: Lesions. In: Pouratian, N., Sheth, S. (eds) Stereotactic and Functional Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-34906-6_21

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