{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:54:32Z","timestamp":1791381272108,"version":"4.3.3"},"reference-count":13,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,19]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>MRI-guided focused ultrasound (MRgFUS) thalamotomy is an effective ablative procedure for medication-refractory essential tremor (ET). However, limited data exist regarding its safety in patients with coexisting intracranial disease such as cerebral cavernous malformations. We present a man in his late 60s with medication-refractory ET who underwent staged bilateral MRgFUS thalamotomy. Preoperative MRI demonstrated heterogeneously T1-hyperintense and T2-hyperintense lesions in the left caudate head and basal ganglia consistent with cavernous malformations, with an associated developmental venous anomaly and no prior haemorrhage. After individualised counselling regarding unknown procedural risks, the patient underwent right-sided thalamotomy, followed 1 year later by left-sided thalamotomy. MRI after each procedure demonstrated expected treatment-related changes without acute intracranial haemorrhage around the cavernous malformations. This case demonstrates successful staged bilateral MRgFUS thalamotomy in a patient with cerebral cavernous malformations, suggesting they may not uniformly preclude MRgFUS in carefully selected patients. Preoperative planning, counselling and MRI surveillance remain essential.<\/jats:p>","DOI":"10.1136\/bcr-2026-275492","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:15:20Z","timestamp":1791378920000},"page":"e275492","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Staged bilateral MR-guided focused ultrasound thalamotomy in a patient with cerebral cavernous malformations"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5396-3757","authenticated-orcid":false,"given":"Matthew C","family":"Henn","sequence":"first","affiliation":[{"name":"Surgery, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R","family":"Cleary","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"2026100706151512000_19.10.e275492.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70322-7"},{"key":"2026100706151512000_19.10.e275492.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1707928"},{"key":"2026100706151512000_19.10.e275492.3","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1001\/jamaneurol.2017.3129","article-title":"A Review of the Current Therapies, Challenges, and Future Directions of Transcranial Focused Ultrasound Technology","volume":"75","author":"Krishna","year":"2018","journal-title":"JAMA Neurol"},{"key":"2026100706151512000_19.10.e275492.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600159"},{"key":"2026100706151512000_19.10.e275492.5","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2020-325278"},{"key":"2026100706151512000_19.10.e275492.6","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1001\/jamaneurol.2024.2295","article-title":"Safety and Efficacy of Staged, Bilateral Focused Ultrasound Thalamotomy in Essential Tremor: An Open-Label Clinical Trial","volume":"81","author":"Kaplitt","year":"2024","journal-title":"JAMA Neurol"},{"key":"2026100706151512000_19.10.e275492.7","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1002\/mds.28716","article-title":"Bilateral Focused Ultrasound Thalamotomy for Essential Tremor (BEST-FUS Phase 2 Trial)","volume":"36","author":"Iorio-Morin","year":"2021","journal-title":"Mov Disord"},{"key":"2026100706151512000_19.10.e275492.8","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyx091"},{"key":"2026100706151512000_19.10.e275492.9","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.3171\/2016.3.JNS152419","article-title":"Hemorrhage from cerebral cavernous malformations: a systematic pooled analysis","volume":"126","author":"Gross","year":"2017","journal-title":"J Neurosurg"},{"key":"2026100706151512000_19.10.e275492.10","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/B978-0-444-63640-9.00024-2","article-title":"Radiology and imaging for cavernous malformations","volume":"143","author":"Wang","year":"2017","journal-title":"Handb Clin Neurol"},{"key":"2026100706151512000_19.10.e275492.11","doi-asserted-by":"crossref","first-page":"2524","DOI":"10.1038\/s41598-021-82271-8","article-title":"Preoperative imaging findings in patients undergoing transcranial magnetic resonance imaging-guided focused ultrasound thalamotomy","volume":"11","author":"Gagliardo","year":"2021","journal-title":"Sci Rep"},{"key":"2026100706151512000_19.10.e275492.12","doi-asserted-by":"crossref","unstructured":"Cahill J , Useinovic N , Toader A , et al . Direct targeting for focused ultrasound thalamotomy in the treatment of movement disorders. J Neurosurg 2026;1\u201313. doi:10.3171\/2026.2.JNS252280","DOI":"10.3171\/2026.2.JNS252280"},{"key":"2026100706151512000_19.10.e275492.13","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1227\/neu.0000000000003663","article-title":"Brain Bleeding Associated With Cavitation During Focused Ultrasound Ablation","volume":"97","author":"Mart\u00ednez-Fern\u00e1ndez","year":"2025","journal-title":"Neurosurgery"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-275492","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:15:22Z","timestamp":1791378922000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-275492"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":13,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,7]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bcr-2026-275492"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-275492","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}