Essential Tremor: Lesions

  • Shayan Moosa
  • W. Jeffrey EliasEmail author


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.


Essential tremor Movement disorders Cerebral lesioning Ablative surgery Thalamotomy Ventral intermediate nucleus Stereotactic surgery Radiofrequency ablation Gamma Knife radiosurgery Focused ultrasound 



American Academy of Neurology


Anterior commissure


Anterior choroidal artery


Apparent diffusion coefficient


Activities of daily living


Clinical Rating Scale for Tremor


Cerebrospinal fluid


Computed tomography


Deep brain stimulation


Dentatorubrothalamic tract


Diffusion-weighted imaging


Gamma Knife


Gamma Knife radiosurgery


Intercommissural line


Midcommissural point


Microelectrode recording




Magnetic resonance-guided focused ultrasound


Magnetic resonance imaging


Posterior commissure


Parkinson’s disease


Posterior subthalamic area




Skull density ratio


Susceptibility-weighted imaging


Ventralis caudalis


Ventral intermediate




Ventralis oralis posterior


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Neurological SurgeryUniversity of VirginiaCharlottesvilleUSA
  2. 2.Departments of Neurological Surgery and NeurologyUniversity of VirginiaCharlottesvilleUSA

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