title: A comparison of surgical approaches for the management of tremor: radiofrequency thalamotomy, gamma knife thalamotomy and thalamic stimulation.
abstract: OBJECTIVE
  Between April 1994 and January 1999, 39 stereotactic procedures for patients with intractable tremor were performed at the University of Pittsburgh Medical Center. A retrospective analysis of results of radiosurgical thalamotomy (n = 15), MR-guided stereotactic radiofrequency thalamotomy (n = 13), and deep brain thalamic stimulation (DBS; n = 11) was performed to study relative advantages and risks of these procedures.
  
  
  METHODS
  All options were discussed with the patients, but radiosurgery usually was performed in elderly patients with concurrent medical problems. Stereotactic thalamotomy and DBS was performed with MR guidance and macrostimulation. For radiosurgery, a median dose of 140 Gy (range 130-150 Gy) was delivered using a single 4-mm collimator.
  
  
  RESULTS
  Of the 13 patients who underwent radiofrequency thalamotomy, 5 had immediate complete arrest of tremor, 6 had a significant reduction and 2 had partial reduction. All 11 patients who underwent DBS had excellent control of tremor immediately after the procedure, and in longer-term follow-up 10/11 maintained excellent tremor control. Of the 12 evaluable radiosurgery patients, 10 noted excellent relief and 2 had partial relief.
  
  
  CONCLUSIONS
  Stereotactic procedures for tremor control are safe and effective. Each procedure has specific advantages and disadvantages that are important for patient selection.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: A
authors.initials: A
authors.lastname: Niranjan
authors.forename: A
authors.initials: A
authors.lastname: Jawahar
authors.forename: D
authors.initials: D
authors.lastname: Kondziolka
authors.forename: L D
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy; D004598:Electrosurgery; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014202:Tremor / Q000601:surgery / Q000628:therapy*