Thalamotomy

Thalamotomy involves creation of lesions in VIM thalamic nucleus in the brain and is quite effective in treating patients with essential, cerebellar, or Parkinsonian tremor.

Overview

Thalamotomy involves creation of lesions in VIM thalamic nucleus in the brain and is quite effective in treating patients with essential, cerebellar, or Parkinsonian tremor.

  • 80-90% reduction in limb tremor(with most complete or almost complete reduction in tremor)
  • In general affects are much more dramatic then medications – Bilateral lesioning generally not done b/c of side effects
  • Advantage over DBS that no hardware, no programming

Thalamic Deep Brain Stimulation (DBS) uses implantable electrodes to send high-frequency electrical signals to the thalamus.

  • 60-90% improvement in tremor on average
  • Fewer side effects then thalamotomy
  • May have benefit for bilateral implantation for voice and head tremor

The most preferred thalamic target is Vim (Ventrointermedius) nucleus of thalamus as defined by Hassler .  Vim is a strip of thalamic nucleus located just anterior to the sensory thalamus. The dimensions of the Vim nucleus are 3 to 4 mm rostrocaudally, about 10 mm in width, and about 10 mm in height.

The axial map of the thalamus showing the location of thalamic target (marked in red).