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Functional lesional neurosurgery for tremor: back to the future?
  1. Sebastian R Schreglmann1,2,
  2. Joachim K Krauss3,
  3. Jin Woo Chang4,
  4. Ernst Martin5,
  5. Beat Werner5,
  6. Ronald Bauer6,
  7. Stefan Hägele-Link1,
  8. Kailash P Bhatia2,
  9. Georg Kägi1
  1. 1Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
  2. 2Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
  3. 3Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
  4. 4Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
  5. 5Center for Focused Ultrasound, University of Zurich, Children’s Hospital Zurich, Zurich, Switzerland
  6. 6Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
  1. Correspondence to Dr Georg Kägi, Department of Neurology, Kantonsspital St.Gallen, St.Gallen 9007, Switzerland; georg.kaegi{at}


For nearly a century, functional neurosurgery has been applied in the treatment of tremor. While deep brain stimulation has been in the focus of academic interest in recent years, the establishment of incisionless technology, such as MRI-guided high-intensity focused ultrasound, has again stirred interest in lesional approaches.

In this article, we will discuss the historical development of surgical technique and targets, as well as the technological state-of-the-art of conventional and incisionless interventions for tremor due to Parkinson’s disease, essential and dystonic tremor and tremor related to multiple sclerosis (MS) and midbrain lesions. We will also summarise technique-inherent advantages of each technology and compare their lesion characteristics. From this, we identify gaps in the current literature and derive future directions for functional lesional neurosurgery, in particularly potential trial designs, alternative targets and the unsolved problem of bilateral lesional treatment. The results of a systematic review and meta-analysis of the consistency, efficacy and side effect rate of lesional treatments for tremor are presented separately alongside this article.

  • tremor
  • stereotaxic surgery
  • neurosurgery

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  • Contributors SRS initiated the project, generated the figures and wrote the manuscript draft. JKK wrote several manuscript chapters and critically reviewed the manuscript. JWC critically revised several manuscript chapters and reviewed the manuscript. SH-L, BW and EM critically reviewed the manuscript. KPB provided input on manuscript structure and critically reviewed the manuscript. GK initiated and supervised the project and critically reviewed the manuscript. All authors agreed on the final manuscript draft.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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