Current Approach to Surgical Management of Tremor Disorders

Abstract: Essential tremor (ET) is the most common cause of tremor worldwide and can become profoundly disabling in many patients, with pharmacological treatments often providing insufficient relief. Surgical interventions have emerged as effective strategies for long-term tremor control. This review summarizes the current evidence on surgical therapies, including deep brain stimulation (DBS), radiofrequency (RF) thalamotomy, magnetic resonance-guided focused ultrasound (MRgFUS), and Gamma Knife radiosurgery (GKSR) for ET and other tremor-inducing syndromes. These techniques demonstrate comparable efficacy. DBS offers the advantage of adjustable parameters, allowing optimization of the therapeutic window while minimizing adverse effects. MRgFUS is particularly attractive due to its minimally invasive nature, whereas RF thalamotomy and GKSR remain viable alternatives for patients who are ineligible for DBS or MRgFUS. Bilateral interventions are increasingly feasible, and treatment selection should be individualized, considering clinical characteristics and patient preference. Ongoing advances in magnetic resonance imaging (MRI) technology and neurostimulation are poised to further refine surgical management and improve outcomes for patients with tremor.