{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T14:37:02Z","timestamp":1792766222168,"version":"4.5.0"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The surgical management of disabling tremor has gained renewed vigor with the availability of deep brain stimulation. However, in the face of an aging population of patients with increasing surgical comorbidities, noninvasive approaches for tremor management are needed. The authors' purpose was to study the technique and results of stereotactic radiosurgery performed in the era of MRI targeting.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors evaluated outcomes in 86 patients (mean age 71 years; number of procedures 88) who underwent a unilateral Gamma Knife thalamotomy (GKT) for tremor during a 15-year period that spanned the era of MRI-based target selection (1996\u20132011). Symptoms were related to essential tremor in 48 patients (19 age \u2265 80 years and 3 age \u2265 90 years), Parkinson disease in 27 patients (11 age \u2265 80 years [1 patient underwent bilateral procedures]), and multiple sclerosis in 11 patients (1 patient underwent bilateral procedures). A single 4-mm isocenter was used to deliver a maximum dose of 140 Gy to the posterior-inferior region of the nucleus ventralis intermedius. The Fahn-Tolosa-Marin clinical tremor rating scale was used to grade tremor, handwriting, and ability to drink. The median follow-up was 23 months.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The mean tremor score was 3.28 \u00b1 0.79 before and 1.81 \u00b1 1.15 after (p &lt; 0.0001) GKT; the mean handwriting score was 2.78 \u00b1 0.82 and 1.62 \u00b1 1.04, respectively (p &lt; 0.0001); and the mean drinking score was 3.14 \u00b1 0.78 and 1.80 \u00b1 1.15, respectively (p &lt; 0.0001). After GKT, 57 patients (66%) showed improvement in all 3 scores, 11 patients (13%) in 2 scores, and 2 patients (2%) in just 1 score. In 16 patients (19%) there was a failure to improve in any score. Two patients developed a temporary contralateral hemiparesis, 1 patient noted dysphagia, and 1 sustained facial sensory loss.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Gamma Knife thalamotomy in the MRI era was a safe and effective noninvasive surgical strategy for medically refractory tremor in the elderly or those with contraindications to deep brain stimulation or stereotactic radiofrequency (thermal) thalamotomy.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.1.jns121111","type":"journal-article","created":{"date-parts":[[2013,2,1]],"date-time":"2013-02-01T18:36:17Z","timestamp":1359743777000},"page":"713-718","source":"Crossref","is-referenced-by-count":86,"title":["Gamma Knife thalamotomy for tremor in the magnetic resonance imaging era"],"prefix":"10.3171","volume":"118","author":[{"given":"Ali","family":"Kooshkabadi","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Tonetti","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Kondziolka","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns121111","series-title":"Parkinson's Disease and Movement Disorders","first-page":"271","article-title":"Clinical rating scale for tremor","year":"1993"},{"key":"b2-jns121111","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"723","DOI":"10.3171\/jns.1991.75.5.0723","article-title":"Stereotactic ventrolateralis thalamotomy for medically refractory tremor in post-levodopa era Parkinson's disease patients","volume":"75","author":"Fox","year":"1991"},{"key":"b3-jns121111","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1002\/mds.1089","article-title":"Long-term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor","volume":"16","author":"Koller","year":"2001"},{"key":"b4-jns121111","series-title":"Radiosurgery","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1159\/000062358","article-title":"Histology of the 100 Gy thalamotomy in the baboon","volume":"4","author":"Kondziolka","year":"2002"},{"key":"b5-jns121111","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/S0090-3019(00)00348-7","article-title":"The future of radiosurgery: radiobiology, technology, and applications","volume":"54","author":"Kondziolka","year":"2000"},{"key":"b6-jns121111","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"111","DOI":"10.3171\/JNS\/2008\/108\/01\/0111","article-title":"Gamma Knife thalamotomy for essential tremor","volume":"108","author":"Kondziolka","year":"2008"},{"key":"b7-jns121111","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"400","DOI":"10.3171\/jns.2005.103.3.0400","article-title":"Thalamic deep brain stimulation for management of essential tremor","volume":"103","author":"Lee","year":"2005"},{"key":"b8-jns121111","series-title":"Arch Neurol","first-page":"584","article-title":"Gamma knife thalamotomy for disabling tremor: a blinded evaluation","volume":"67","author":"Lim","year":"2010"},{"key":"b9-jns121111","series-title":"Mov Disord","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1002\/mds.870130105","article-title":"How common is the most common adult movement disorder? Estimates of the prevalence of essential tremor throughout the world","volume":"13","author":"Louis","year":"1998"},{"key":"b10-jns121111","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1227\/NEU.0b013e3182350893","article-title":"Gamma knife thalamotomy for Parkinson disease and essential tremor: a prospective multicenter study","volume":"70","author":"Ohye","year":"2012"},{"key":"b11-jns121111","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1097\/00006123-199811000-00001","article-title":"Ablative surgery and deep brain stimulation for Parkinson's disease","volume":"43","author":"Starr","year":"1998"},{"key":"b12-jns121111","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1227\/01.NEU.0000375506.18902.3E","article-title":"Deep brain stimulation of the ventral intermediate nucleus of the thalamus for tremor in patients with multiple sclerosis","volume":"67","author":"Torres","year":"2010"},{"key":"b13-jns121111","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3171\/jns.1998.89.2.0183","article-title":"Gamma knife radiosurgery as a lesioning technique in movement disorder surgery","volume":"89","author":"Young","year":"1998"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/118\/4\/article-p713.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/118\/4\/article-p713.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/118\/4\/article-p713.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,14]],"date-time":"2022-08-14T17:45:47Z","timestamp":1660499147000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/118\/4\/article-p713.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2013,4]]},"references-count":13,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2013.1.jns121111","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,4]]}}}