Functional lesional neurosurgery for tremor: back to the future?

Area of Science:

• Neurosurgery
• Neurology
• Medical Technology

Background:

• Functional neurosurgery has a century-long history in tremor management.
• Deep brain stimulation is a recent focus, but incisionless techniques like MRI-guided focused ultrasound are renewing interest in lesional neurosurgery.
• Tremor conditions addressed include Parkinson's disease, essential tremor, dystonic tremor, and tremors associated with multiple sclerosis and midbrain lesions.

Purpose of the Study:

• To discuss the historical evolution of surgical techniques and targets in functional neurosurgery for tremor.
• To review the current state-of-the-art in both conventional and incisionless (MRI-guided focused ultrasound) interventions.
• To identify research gaps and propose future directions for functional lesional neurosurgery.

Main Methods:

• Review of historical development of surgical techniques and targets.
• Analysis of the technological advancements in conventional and incisionless interventions.
• Comparison of technique-inherent advantages and lesion characteristics.
• Identification of literature gaps and future research directions.
• Reference to a separate systematic review and meta-analysis on lesional treatments for tremor.

Main Results:

• Discussion of historical and current surgical approaches for tremor.
• Comparison of advantages and lesion characteristics of different technologies.
• Identification of challenges, including bilateral treatment and need for trial designs.

Conclusions:

• Functional lesional neurosurgery, including incisionless techniques, remains a relevant approach for tremor treatment.
• Further research is needed to address current literature gaps, optimize trial designs, and explore alternative targets.
• The challenge of bilateral lesional treatment requires innovative solutions.