{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:26:13Z","timestamp":1787495173064,"version":"build-2736575974"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"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":[[2026,3,30]]},"abstract":"\n BACKGROUND<\/jats:title>\n Magnetic resonance\u2013guided focused ultrasound (MRgFUS) has emerged as a minimally invasive alternative for medication-refractory Parkinson\u2019s disease tremor. While single-target ablation of either the subthalamic nucleus (STN) or the ventral intermediate nucleus (VIM) is standard, intraoperative adaptation to address incomplete symptom relief remains largely unexplored.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present the case of a 70-year-old man with an 8-year history of Parkinson\u2019s disease who underwent planned unilateral left STN MRgFUS. Following lesioning, marked improvement in bradykinesia and rigidity was observed; however, residual tremor (approximately 30% of baseline) persisted. Based on intraoperative clinical assessment, an additional VIM lesion was performed within the same session, resulting in complete tremor resolution without adverse effects.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This report illustrates the technical feasibility and safety of dual-target MRgFUS for Parkinson\u2019s disease, achieved through intraoperative, symptom-guided decision-making. To the authors\u2019 knowledge, this represents the first documented case of combined STN and VIM ablation within a single MRgFUS session, highlighting a potential framework for adaptive, multitarget lesioning in functional neurosurgery.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE2643<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case2643","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:04:50Z","timestamp":1775642690000},"source":"Crossref","is-referenced-by-count":1,"title":["Dual-target magnetic resonance\u2013guided focused ultrasound of the subthalamic and ventral intermediate nuclei for Parkinson\u2019s disease: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Francisco","family":"Rivera","sequence":"first","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n CENIT para la Investigaci\u00f3n en Neurociencias, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3812-5899","authenticated-orcid":true,"given":"Nelson","family":"Quintanal Cordero","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n CENIT para la Investigaci\u00f3n en Neurociencias, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n CENIT para la Investigaci\u00f3n en Neurociencias, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Luis","family":"Etcheverry","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n CENIT para la Investigaci\u00f3n en Neurociencias, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Pampin","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n CENIT para la Investigaci\u00f3n en Neurociencias, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabi\u00e1n","family":"Piedimonte","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n CENIT para la Investigaci\u00f3n en Neurociencias, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Tremor Other Hyperkinet Mov (N Y)","first-page":"18","article-title":"High intensity focused ultrasound\u2014longitudinal data on efficacy and safety","volume":"15","author":"Thomas","year":"2025","unstructured":"Thomas BBellini GLee WYShi YMogilner APourfar MH.High intensity focused ultrasound\u2014longitudinal data on efficacy and safety. Tremor Other Hyperkinet Mov (N Y). 2025;15:18. doi:10.5334\/tohm.987"},{"issue":"5","key":"bib2","series-title":"Mov Disord","first-page":"823","article-title":"Comparative study of focused ultrasound unilateral thalamotomy and subthalamotomy for medication-refractory Parkinson\u2019s disease tremor","volume":"40","author":"Paschen","year":"2025","unstructured":"Paschen SNatera-Villalba EPineda-Pardo JAComparative study of focused ultrasound unilateral thalamotomy and subthalamotomy for medication-refractory Parkinson\u2019s disease tremor. 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JAMA Neurol. 2017;74(12):1412-1418. doi:10.1001\/jamaneurol.2017.3098"},{"issue":"5","key":"bib4","series-title":"Mov Disord Clin Pract","first-page":"681","article-title":"The role of focused ultrasound in the management of movement disorders: insights after 5 years of experience","volume":"8","author":"Mart\u00ednez-Fern\u00e1ndez","year":"2021","unstructured":"Mart\u00ednez-Fern\u00e1ndez RMatarazzo MM\u00e1\u00f1ez-Mir\u00f3 JUObeso JA.The role of focused ultrasound in the management of movement disorders: insights after 5 years of experience. 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Tremor Other Hyperkinet Mov (N Y). 2015;5:321. doi:10.7916\/D81V5D35"},{"issue":"3","key":"bib6","series-title":"Mov Disord","first-page":"478","article-title":"Magnetic resonance-guided focused ultrasound thalamotomy in a prospective cohort of 52 patients with Parkinson\u2019s disease: a possible critical role of age and lesion volume for predicting tremor relapse","volume":"40","author":"Braccia","year":"2025","unstructured":"Braccia AGolfr\u00e8 Andreasi NGhielmetti FMagnetic resonance-guided focused ultrasound thalamotomy in a prospective cohort of 52 patients with Parkinson\u2019s disease: a possible critical role of age and lesion volume for predicting tremor relapse. 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Neuromodulation. 2005;8(1):1-6. doi:10.1111\/j.1094-7159.2005.05214.x"},{"issue":"3","key":"bib13","series-title":"Stereotact Funct Neurosurg","first-page":"250","article-title":"Successful unilateral surgical approach to internal globus pallidus and ventral intermediate nucleus of the thalamus in 3 cases of myoclonus-dystonia syndrome","volume":"99","author":"Mercado-Pimentel","year":"2021","unstructured":"Mercado-Pimentel RPiedimonte FMicheli FSuccessful unilateral surgical approach to internal globus pallidus and ventral intermediate nucleus of the thalamus in 3 cases of myoclonus-dystonia syndrome. Stereotact Funct Neurosurg. 2021;99(3):250-255. doi:10.1159\/000511715"},{"issue":"2-3","key":"bib14","series-title":"Brain Res Bull","first-page":"113","article-title":"Multi-target strategy for parkinsonian patients: the role of deep brain stimulation in the centromedian-parafascicularis complex","volume":"78","author":"Stefani","year":"2009","unstructured":"Stefani APeppe APierantozzi MMulti-target strategy for parkinsonian patients: the role of deep brain stimulation in the centromedian-parafascicularis complex. 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JAMA Neurol. 2017;74(12):1412-1418. doi:10.1001\/jamaneurol.2017.3098"},{"issue":"5","key":"bib4","series-title":"Mov Disord Clin Pract","first-page":"681","article-title":"The role of focused ultrasound in the management of movement disorders: insights after 5 years of experience","volume":"8","author":"Mart\u00ednez-Fern\u00e1ndez","year":"2021","unstructured":"Mart\u00ednez-Fern\u00e1ndez RMatarazzo MM\u00e1\u00f1ez-Mir\u00f3 JUObeso JA.The role of focused ultrasound in the management of movement disorders: insights after 5 years of experience. Mov Disord Clin Pract. 2021;8(5):681-687. doi:10.1002\/mdc3.13223"},{"key":"bib5","series-title":"Tremor Other Hyperkinet Mov (N Y)","first-page":"321","article-title":"Comparison of VIM and STN DBS for parkinsonian resting and postural\/action tremor","volume":"5","author":"Parihar","year":"2015","unstructured":"Parihar RAlterman RPapavassiliou ETarsy DShih LC.Comparison of VIM and STN DBS for parkinsonian resting and postural\/action tremor. Tremor Other Hyperkinet Mov (N Y). 2015;5:321. doi:10.7916\/D81V5D35"},{"issue":"3","key":"bib6","series-title":"Mov Disord","first-page":"478","article-title":"Magnetic resonance-guided focused ultrasound thalamotomy in a prospective cohort of 52 patients with Parkinson\u2019s disease: a possible critical role of age and lesion volume for predicting tremor relapse","volume":"40","author":"Braccia","year":"2025","unstructured":"Braccia AGolfr\u00e8 Andreasi NGhielmetti FMagnetic resonance-guided focused ultrasound thalamotomy in a prospective cohort of 52 patients with Parkinson\u2019s disease: a possible critical role of age and lesion volume for predicting tremor relapse. Mov Disord. 2025;40(3):478-489. doi:10.1002\/mds.30093"},{"key":"bib7","series-title":"Tremor Other Hyperkinet Mov (N Y)","first-page":"29","article-title":"Tremor in Parkinson\u2019s disease: from pathophysiology to advanced therapies","volume":"12","author":"Abusrair","year":"2022","unstructured":"Abusrair AHElsekaily WBohlega S.Tremor in Parkinson\u2019s disease: from pathophysiology to advanced therapies. 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