{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:42:44Z","timestamp":1791420164465,"version":"4.3.3"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Accurate targeting of the ventral intermediate nucleus (VIM) remains a critical challenge in thalamotomy for essential tremor (ET) and tremor-dominant Parkinson\u2019s disease (TDPD). Indirect atlas-based methods suffer from anatomical variability and poor visualization of thalamic substructures. Here, the authors evaluated the clinical impact of a direct targeting strategy enabled by fast gray matter acquisition T1 inversion recovery (FGATIR) imaging in MR-guided focused ultrasound (MRgFUS) thalamotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a retrospective cohort study of adult patients who underwent first-time MRgFUS thalamotomy for ET or TDPD at the Oregon Health &amp; Science University between August 2023 and January 2025. Patients treated with FGATIR-guided direct targeting (n = 64, 40 males) were matched to a cohort treated using indirect targeting combined with physiological mapping (n = 52, 36 males). Data were collected from intraoperative recordings and postprocedural imaging, as well as at 1-day, 1-month, and 3-month follow-up evaluations. Procedural efficiency, lesion and edema characteristics, tract involvement, clinical outcomes, and adverse events were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>FGATIR-guided direct targeting significantly reduced the number of sonications (\u221222%), total sonication time (\u221232%), and overall procedural duration (\u221233%) compared with indirect targeting. Lesion volumes (\u221221%) and perilesional edema (\u221228%) were smaller in the direct targeting group with less impingement on the internal capsule and medial lemniscus. Direct targeting resulted in a lower incidence of acute balance (\u221231%), weakness (\u221225%), sensory (\u221234%), and speech (\u221212%) deficits while producing a 14% greater quantitative tremor reduction. Both groups achieved similar subjective tremor control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>FGATIR-based direct targeting improves the safety, precision, and efficiency of MRgFUS thalamotomy without compromising clinical benefit. The FGATIR sequence is widely available on 1.5T and 3T Siemens MRI systems, and this method may be adapted for use with other targets for stereotactic ablation. This direct targeting technique would also be applicable to other forms of thalamotomy, such as Gamma Knife radiosurgery and radiofrequency, further expanding its utility. Direct targeting represents a scalable and patient-centered advancement for stereotactic thalamotomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.2.jns252280","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:18:33Z","timestamp":1782865113000},"page":"1-13","source":"Crossref","is-referenced-by-count":2,"title":["Direct targeting for focused ultrasound thalamotomy in the treatment of movement disorders"],"prefix":"10.3171","author":[{"given":"James","family":"Cahill","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland;"},{"name":"School of Medicine, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nemanja","family":"Useinovic","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Toader","sequence":"additional","affiliation":[{"name":"College of Medicine, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna E.","family":"Minns","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland;"},{"name":"School of Medicine, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beck","family":"Shafie","sequence":"additional","affiliation":[{"name":"School of Medicine, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew C.","family":"Henn","sequence":"additional","affiliation":[{"name":"School of Medicine, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Lipson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Cleary","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland;"},{"name":"Department of Surgery, Portland Veterans Affairs Medical Center, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Magn Reson Imaging Clin N Am","first-page":"661","article-title":"MR-guided focused ultrasound thalamotomy for chronic pain","volume":"32","author":"Colasurdo M","year":"2024","unstructured":"Colasurdo M, Ahmed AK, Gandhi D. MR-guided focused ultrasound thalamotomy for chronic pain. Magn Reson Imaging Clin N Am. 2024;32(4):661\u2013672. doi:10.1016\/j.mric.2024.04.005"},{"issue":"8","key":"b2","series-title":"Lancet Neurol","first-page":"698","article-title":"Focused ultrasound therapy for movement disorders","volume":"24","author":"Mart\u00ednez-Fern\u00e1ndez R","year":"2025","unstructured":"Mart\u00ednez-Fern\u00e1ndez R, Paschen S, Del \u00c1lamo M,  Focused ultrasound therapy for movement disorders. Lancet Neurol. 2025;24(8):698\u2013712. doi:10.1016\/S1474-4422(25)00210-8"},{"key":"b3","series-title":"World Neurosurg","first-page":"443","article-title":"Outcomes in lesion surgery versus deep brain stimulation in patients with tremor: a systematic review and meta-analysis","volume":"123","author":"Altinel Y","year":"2019","unstructured":"Altinel Y, Alkhalfan F, Qiao N, Velimirovic M. Outcomes in lesion surgery versus deep brain stimulation in patients with tremor: a systematic review and meta-analysis. World Neurosurg. 2019;123:443\u2013452.e8. doi:10.1016\/j.wneu.2018.11.175"},{"issue":"4","key":"b4","series-title":"J Neurosurg","first-page":"1028","article-title":"Magnetic resonance imaging\u2013guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results","volume":"138","author":"Cosgrove GR","year":"2023","unstructured":"Cosgrove GR, Lipsman N, Lozano AM,  Magnetic resonance imaging\u2013guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results. 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The significance in human stereotactic brain surgery of individual variation in the diencephalon and globus pallidus. J Neurol Neurosurg Psychiat. 1959;22:287\u2013298."},{"key":"b10","series-title":"Front Neurol","first-page":"1370574","article-title":"Magnetic resonance-guided focused ultrasound thalamotomy for essential tremor patients with low skull density ratio: a case-matched analysis","volume":"15","author":"Ng PR","year":"2024","unstructured":"Ng PR, Blitz SE, Chua MMJ, Cosgrove GR. Magnetic resonance-guided focused ultrasound thalamotomy for essential tremor patients with low skull density ratio: a case-matched analysis. 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Front Neurol. 2021;12:654711. doi:10.3389\/fneur.2021.654711"},{"key":"b22","series-title":"medRxiv","article-title":"Combined accelerometry and writing analysis for quantifying tremor during focused ultrasound thalamotomy","author":"Toader AE","unstructured":"Toader AE, Useinovic N, Shafie B,  Combined accelerometry and writing analysis for quantifying tremor during focused ultrasound thalamotomy. medRxiv. doi:10.1101\/2025.07.29.25332395"},{"issue":"4","key":"b23","series-title":"J Neurosurg","first-page":"960","article-title":"The relationship between lesion overlap with automatically segmented structures and treatment outcomes following MR-guided focused ultrasound thalamotomy for tremor","volume":"143","author":"Ito Y","year":"2025","unstructured":"Ito Y, Maesawa S, Kato S,  The relationship between lesion overlap with automatically segmented structures and treatment outcomes following MR-guided focused ultrasound thalamotomy for tremor. 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Mov Disord. 2025;40(11):2540\u20132542. doi:10.1002\/mds.70003"},{"issue":"8","key":"b32","series-title":"Eur Radiol","first-page":"5167","article-title":"Four-tract probabilistic tractography technique for target selection in essential tremor treatment with magnetic resonance-guided focused ultrasound","volume":"34","author":"P\u00e9rez-Garc\u00eda C","year":"2024","unstructured":"P\u00e9rez-Garc\u00eda C, L\u00f3pez-Fr\u00edas A, Arrazola J,  Four-tract probabilistic tractography technique for target selection in essential tremor treatment with magnetic resonance-guided focused ultrasound. 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