First introduced in the 1950s, thalamotomy is an invasive procedure, primarily effective for tremors such as those associated with Parkinson's disease (PD), where a selected portion of the thalamus is surgically destroyed (ablated).

The proton density MRI was demonstrated to be very useful to determine the safest trajectory and tentative target point. However, as a detailed functional localization of the thalamic subnuclei cannot be yet obtained by MRI, the final target should be decided on the basis of electrophysiological findings ¹⁾.

Bilateral procedures are poorly tolerated because of increased complication and risk, including vision and speech problems. The positive effects on tremors are immediate. Other less destructive procedures are sometimes preferred, such as subthalamic deep brain stimulation (DBS), since this procedure can also improve tremors and other symptoms of PD.

Gamma Knife thalamotomy

Magnetic resonance guided focused ultrasound thalamotomy.

Thalamotomy outcome.