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Peer-reviewedCC BY 4.0Tremor and Other Hyperkinetic Movements

Network-Based Deep Brain Stimulation Rescue After Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor: Two Targeting Strategies

  • Francisco Aranda Godoy1,2
  • Evan Wilson1
  • Danielle Pietramalla1
  • Christopher R. Honey1
  • Stefan Lang1
  1. 1Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Neurosurgery, Pontifical Catholic University of Chile, Santiago, Chile
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Abstract

Background:: Tremor may recur after magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy, and the optimal target for deep brain stimulation (DBS) rescue remains uncertain.

Cases:: A 71-year-old man with recurrent essential tremor after ventral intermediate nucleus (Vim) MRgFUS underwent DBS along a Vim-posterior subthalamic area (PSA) trajectory. Microelectrode activity was attenuated in the lesioned thalamus; Vim test stimulation was ineffective, whereas PSA stimulation suppressed tremor. A 79-year-old man with recurrent tremor after staged bilateral MRgFUS underwent left DBS targeting the rubral wing.

Conclusions:: When the original thalamic target is anatomically or physiologically altered, targeting intact cerebellothalamic pathways provides a rational rescue strategy.

Highlights: Deep brain stimulation can remain effective after failed focused ultrasound thalamotomy. These cases illustrate a lesion-informed, network-based strategy that preserves access to the cerebellothalamic network when prior lesioning has altered local anatomy or physiology.

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Cite

BibTeXRIS
BibTeX
@article{godoy2026networkbased,
  title = {{Network-Based Deep Brain Stimulation Rescue After Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor: Two Targeting Strategies}},
  author = {Francisco Aranda Godoy and Evan Wilson and Danielle Pietramalla and Christopher R. Honey and Stefan Lang},
  journal = {Tremor and Other Hyperkinetic Movements},
  year = {2026},
  month = nov,
  doi = {10.5334/tohm.1279},
  url = {https://doi.org/10.5334/tohm.1279},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Network-Based Deep Brain Stimulation Rescue After Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor: Two Targeting Strategies
AU  - Francisco Aranda Godoy
AU  - Evan Wilson
AU  - Danielle Pietramalla
AU  - Christopher R. Honey
AU  - Stefan Lang
PY  - 2026
DA  - 2026/11/03
JO  - Tremor and Other Hyperkinetic Movements
DO  - 10.5334/tohm.1279
UR  - https://doi.org/10.5334/tohm.1279
AB  - Background:: Tremor may recur after magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy, and the optimal target for deep brain stimulation (DBS) rescue remains uncertain.  Cases:: A 71-year-old man with recurrent essential tremor after ventral intermediate nucleus (Vim) MRgFUS underwent DBS along a Vim-posterior subthalamic area (PSA) trajectory. Microelectrode activity was attenuated in the lesioned thalamus; Vim test stimulation was ineffective, whereas PSA stimulation suppressed tremor. A 79-year-old man with recurrent tremor after staged bilateral MRgFUS underwent left DBS targeting the rubral wing.  Conclusions:: When the original thalamic target is anatomically or physiologically altered, targeting intact cerebellothalamic pathways provides a rational rescue strategy.  Highlights: Deep brain stimulation can remain effective after failed focused ultrasound thalamotomy. These cases illustrate a lesion-informed, network-based strategy that preserves access to the cerebellothalamic network when prior lesioning has altered local anatomy or physiology.
SN  - 2160-8288
ER  -