{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:34:24Z","timestamp":1781627664365,"version":"3.54.5"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"8","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,2,23]]},"abstract":"\n BACKGROUND<\/jats:title>\n While deep brain stimulation (DBS) is an effective therapy for essential tremor (ET), Gamma Knife radiosurgery (GKRS) offers a noninvasive alternative for patients who are poor surgical candidates or who experience DBS-related complications. Although GKRS ventral intermediate nucleus (VIM) thalamotomy is generally safe, very delayed adverse effects are uncommon and not well characterized.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 69-year-old woman with medically refractory ET underwent right VIM DBS, but the device was later explanted due to infection. Because she was high-risk for reimplantation, she proceeded with GKRS VIM thalamotomy. Eight years later, she developed progressive left-sided weakness and gait deviation. MRI revealed a new right thalamic cystic lesion precisely colocalized with the prior GKRS target. Stereotactic aspiration demonstrated acellular, proteinaceous fluid without evidence of malignancy or infection, consistent with a delayed postradiosurgical cyst. Neurological function improved following drainage.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Delayed cyst formation may occur many years after GKRS VIM thalamotomy and should be recognized as a rare but clinically significant late complication. Given the typical 7- to 10-year latency observed across radiosurgical cystogenesis, long-term but low-frequency MRI surveillance, such as a 1-year posttreatment baseline followed by imaging every 2\u20133 years or sooner with new neurological symptoms, may facilitate earlier detection and intervention.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25725<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25725","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:47:19Z","timestamp":1771847239000},"source":"Crossref","is-referenced-by-count":2,"title":["Delayed cyst formation following ventral intermediate nucleus thalamotomy by Gamma Knife radiosurgery for essential tremor: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7884-6394","authenticated-orcid":true,"given":"Neil D.","family":"Almeida","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2410-7588","authenticated-orcid":true,"given":"Shefalika","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8084-3985","authenticated-orcid":true,"given":"Sarthak","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9746-7931","authenticated-orcid":true,"given":"Victor","family":"Goulenko","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0219-3782","authenticated-orcid":true,"given":"Amanda","family":"Holowatyj","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4567-6191","authenticated-orcid":true,"given":"Alex","family":"Fritz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6636-3996","authenticated-orcid":true,"given":"Harshini K.","family":"Cheruvu","sequence":"additional","affiliation":[{"name":"Department of Statistics & Data Science, Cornell University, Ithaca"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1449-668X","authenticated-orcid":true,"given":"Hanna","family":"Algattas","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9388-9876","authenticated-orcid":true,"given":"Robert","family":"Plunkett","sequence":"additional","affiliation":[{"name":"Department of Neuro-oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6615-4235","authenticated-orcid":true,"given":"Dheerendra","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York"},{"name":"Department of Radiation Medicine and"},{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Curr Treat Options Neurol","first-page":"19","article-title":"The efficacy of deep brain stimulation in the treatment of essential tremor: a systematic review","volume":"27","author":"Aderinto","year":"2025","unstructured":"Aderinto NAbraham ICOlatunji GKokori EYusuf IAIsarinade DT.The efficacy of deep brain stimulation in the treatment of essential tremor: a systematic review. 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World J Surg Oncol. 2010;8:20. doi:10.1186\/1477-7819-8-20"},{"issue":"5","key":"bib4","series-title":"AJNR, Am J Neuroradiol","first-page":"1152","article-title":"Tumefactive cysts: a delayed complication following radiosurgery for cerebral arterial venous malformations","volume":"26","author":"Edmister","year":"2005","unstructured":"Edmister WBLane JIGilbertson JRBrown RDPollock BE.Tumefactive cysts: a delayed complication following radiosurgery for cerebral arterial venous malformations. AJNR, Am J Neuroradiol. 2005;26(5):1152-1157"},{"issue":"4","key":"bib5","series-title":"Neurosurgery","first-page":"689","article-title":"Delayed cyst formation after Gamma Knife radiosurgery for brain metastases","volume":"65","author":"Ishikawa","year":"2009","unstructured":"Ishikawa EYamamoto MSaito ADelayed cyst formation after Gamma Knife radiosurgery for brain metastases. Neurosurgery. 2009;65(4):689-94. doi:10.1227\/01.NEU.0000351771.46273.22"},{"issue":"suppl","key":"bib6","series-title":"J Neurosurg","first-page":"34","article-title":"Long-term complications after Gamma Knife surgery for arteriovenous malformations","volume":"102","author":"Izawa","year":"2005","unstructured":"Izawa MHayashi MChernov MLong-term complications after Gamma Knife surgery for arteriovenous malformations. J Neurosurg. 2005;102(suppl):34-37. doi:10.3171\/jns.2005.102.s_supplement.0034"},{"key":"bib7","series-title":"Parkinsonism Relat Disord","first-page":"107700","article-title":"Bilateral thalamic cysts as a delayed complication of radiosurgical treatment in a patient with Parkinson\u2019s disease","volume":"134","author":"Gamaleya","year":"2025","unstructured":"Gamaleya ATomskiy AAsriyants SGolanov A.Bilateral thalamic cysts as a delayed complication of radiosurgical treatment in a patient with Parkinson\u2019s disease. 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J Neurosurg Case Lessons. 2024;8(18):CASE24502. doi:10.3171\/CASE24502"},{"issue":"1","key":"bib1","series-title":"Curr Treat Options Neurol","first-page":"19","article-title":"The efficacy of deep brain stimulation in the treatment of essential tremor: a systematic review","volume":"27","author":"Aderinto","year":"2025","unstructured":"Aderinto NAbraham ICOlatunji GKokori EYusuf IAIsarinade DT.The efficacy of deep brain stimulation in the treatment of essential tremor: a systematic review. 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Stereotact Funct Neurosurg. 2013;91(5):338-341. doi:10.1159\/000350021"},{"key":"bib12","series-title":"Mov Disord","first-page":"431","article-title":"Incidental asymptomatic intraparenchymal cysts following DBS placement","volume":"29","author":"Baxi","year":"2014","unstructured":"Baxi NPourfar MMogilner A.Incidental asymptomatic intraparenchymal cysts following DBS placement. Mov Disord. 2014;29:431-432"},{"issue":"18","key":"bib13","series-title":"J Neurosurg Case Lessons","first-page":"CASE24502","article-title":"Lesion-like effect of gliosis secondary to deep brain stimulation electrode infection: illustrative case","volume":"8","author":"Vilela-Filho","year":"2024","unstructured":"Vilela-Filho OOliveira-Alves DAlvim-Alves DSilva DJ.Lesion-like effect of gliosis secondary to deep brain stimulation electrode infection: illustrative case. 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