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Semin Neurol
DOI: 10.1055/a-2789-0271
Review Article

Current Approach to Surgical Management of Tremor Disorders

Authors

  • Gerardo Chavira-Hernandez

    1   Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
    2   Division of Neurology, University of Toronto, Toronto, Ontario, Canada

  • Alfonso Fasano

    1   Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
    2   Division of Neurology, University of Toronto, Toronto, Ontario, Canada
    3   Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
    4   Department of Biomedical Sciences, Humanitas University, Milan, Italy
    5   IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

Funding Information This work was supported by the University of Toronto and the University Health Network Chair in Neuromodulation to AF.
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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.

Keywords

tremor - deep brain stimulation - Gamma Knife stereotactic radiosurgery - magnetic resonance-guided focused ultrasound - radiofrequency thalamotomy

Contributors' Statement

G.C-H. contributed to the investigation and methodology and was involved in writing the original draft as well as review and editing. A.F. was responsible for conceptualization, formal analysis, investigation, methodology, project administration, resources, supervision, validation, visualization, and writing, including review and editing.




Publication History

Received: 20 December 2025

Accepted: 14 January 2026

Accepted Manuscript online:
15 January 2026

Article published online:
06 February 2026

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