Overview of Thalamotomy

Thalamotomy is a neurosurgical procedure which aims at creating local lesions with the help of thermal energy in the thalamic region of the brain.

These lesions then interferes with the neural circuitry of the brain which helps in control of tremors like those seen in rubral, cerebellar, multiple scelorsis, essential or Parkinson’s  tremor.

The lesions are made in the VentroInteroMedial (VIM) nucleus of the Thalamus.

This procedure results 80-90% reduction in control of limb tremors with the added advantage of no hardware implantation like in Deep Brain Stimulation (DBS) and post-operative programming. The limitation of this procedure is that lesions on both sides of brain cannot be done due to side effects.

Thalamic DBS uses implantable electrodes the tip of which are placed in the VIM nucleus of thalamus and the other end is connected to an implantable battery placed over the chest under the skin. This battery sends electrical currents which then produces desired beneficial effects.

Parkinson’s disease patients with severe asymmetrical tremor that is unresponsive to medical management.  Generally only unilateral thalamotomies are performed as bilateral procedures have adverse speech and balance and effects.

Most common indications for which we perform thalamotomy include unilateral tremors of all forms of etiology.