Researchers think that the abnormal brain activity that causes essential tremor is processed through a structure deep in the brain called the thalamus. Stereotactic thalamotomy works by destroying part of the thalamus to block the abnormal brain activity from reaching the muscles and causing tremor.
Although thalamotomy is still performed today, it is done less frequently because of the risk of serious side effects and the availability of deep brain stimulation, which is safer and has fewer complications.
John Jerome's spinal cord shines white beneath the surgeons' headlamps, crisscrossed by a web of bright-red blood vessels. He's been on the operating table for more than four hours.
Above the fist-sized opening in his neck hangs a complex steel contraption. It's fixed in place by four posts: two wedged into Jerome's skull and two more in the vertebrae below the surgical wound. Invented by Emory neurosurgeon Nick Boulis, MD, it serves a single purpose: To hold steady the thin needle plunged into...
Most thalamotomies are performed on just one side of the brain -- the side opposite to the most severely affected limb. If done on both sides of the brain, you carry a higher risk of developing severe speech problems or becoming completely mute. You also have a greater risk of developing cognitive (thinking) problems.
What Happens During a Stereotactic Thalamotomy?
A stereotactic thalamotomy takes two to three hours to perform. It is done under local anesthesia (you aren't put to sleep), but because brain tissue feels no pain, the procedure is essentially painless. It is important for the patient to be awake during the procedure so that the surgeon can ask the patient a series of questions and perform a series of tests to localize the part of the brain causing the tremor.
Does Stereotactic Thalamotomy Work?
Yes, approximately 80% of patients who have stereotactic thalamotomy experience long-lasting and near complete (or complete) relief from essential tremor.
What Are the Side Effects of Stereotactic Thalamotomy?
Common, but temporary, side effects of stereotactic thalamotomy include:
Stereotactic thalamotomy should only be performed under rare circumstances, such as when all other treatment options have failed. The procedure causes permanent destruction of the thalamus, which may limit future treatment options.