Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy for Essential Tremor in a Patient with an Arteriovenous Malformation

Tomaima Yousef; Elma A. Chowdhury; Piush Sarkar; Hooman Azmi

doi:10.5334/tohm.1210

Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy for Essential Tremor in a Patient with an Arteriovenous Malformation

Tremor and Other Hyperkinetic Movements

Volume 16 (2026): Issue 1

By: Tomaima Yousef, Elma A. Chowdhury, Piush Sarkar and Hooman Azmi

Open Access

|May 2026

Abstract

Background: Magnetic Resonance Guided Focused Ultrasound Thalamotomy (MRgFUS) is a non-surgical treatment option for medically refractory Essential Tremor (ET) or tremor dominant Parkinson’s Disease.

Case Report: A 75-year-old left-handed man with medically refractory essential tremor presented for MRgFUS evaluation. During workup, contrast-enhanced brain MRI revealed an incidental right frontal arteriovenous malformation. After discussion of management options, the patient elected not to pursue treatment of the newly diagnosed AVM and proceeded with tremor-focused therapy.

Discussion: It is possible to effectively utilize MRgFUS for treatment of tremors in carefully selected patients with cerebral AVMs by designating the malformation as a no pass zone.

References

Gagliardo C, Cannella R, Filorizzo G, et al. Preoperative imaging findings in patients undergoing transcranial magnetic resonance imaging-guided focused ultrasound thalamotomy. Sci Rep. 2021;11(1):2524. Published 2021 Jan 28. DOI: 10.1038/s41598-021-82271-8
Open DOI Search in Google Scholar Back to article
Gonzalez-Quarante LH, Gonzalez-Crespo A, Arcadi A, et al. 3-T MR-guided focused ultrasound thalamotomy for tremor in patients with a cardiac pacemaker: case series and review of the literature. Neurosurg Focus. 2024;57(3):E5. DOI: 10.3171/2024.6.FOCUS24171
Open DOI Search in Google Scholar Back to article
Buch VP, McShane BJ, Beatson N, et al. Focused Ultrasound Thalamotomy with Dentato-Rubro-Thalamic Tractography in Patients with Spinal Cord Stimulators and Cardiac Pacemakers. Stereotact Funct Neurosurg. 2020;98(4):263–269. DOI: 10.1159/000507031
Open DOI Search in Google Scholar Back to article
Abdullah B, Subramaniam R, Omar S, Wragg P, Ramli N, Wui A, Lee C, Yusof Y. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment for uterine fibroids. Biomed Imaging Interv J. 2010 Apr–Jun;6(2):e15. DOI: 10.2349/biij.6.2.e15. Epub 2010 Apr 1. PMID: 21611036. PMCID: PMC3097768.
Open DOI Search in Google Scholar Back to article
Ehdaie B, Tempany CM, Holland F, Sjoberg DD, Kibel AS, Trinh QD, Durack JC, Akin O, Vickers AJ, Scardino PT, Sperling D, Wong JYC, Yuh B, Woodrum DA, Mynderse LA, Raman SS, Pantuck AJ, Schiffman MH, McClure TD, Sonn GA, Ghanouni P. MRI-guided focused ultrasound focal therapy for patients with intermediate-risk prostate cancer: a phase 2b, multicentre study. Lancet Oncol. 2022 Jul;23(7):910–918. DOI: 10.1016/S1470-2045(22)00251-0. Epub 2022 Jun 14. PMID: 35714666. PMCID: PMC9400094.
Open DOI Search in Google Scholar Back to article
Maesawa S, Nakatsubo D, Tsugawa T, et al. [Magnetic Resonance-guided Focused Ultrasound Ablation:Techniques and Neurological Applications]. No Shinkei Geka. 2021;49(4):847–856. DOI: 10.11477/mf.1436204463
Open DOI Search in Google Scholar Back to article
U.S. Food and Drug Administration. Summary of Safety and Effectiveness Data (SSED): ExAblate Model 4000 Type 1.0 System (ExAblate Neuro). Premarket Approval (PMA) P150038: InSightec, Inc.; July 11, 2016.
Search in Google Scholar Back to article
Maamary J, Peters J, Barnett Y, Jonker B, Tisch S. The feasibility of MRI guided focused ultrasound for posttraumatic tremor with prior hemicraniotomy and skull defect [abstract]. Mov Disord. 2023; 38 (suppl 1).
Search in Google Scholar Back to article
Xu Z, Carlson C, Snell J, et al. Intracranial inertial cavitation threshold and thermal ablation lesion creation using MRI-guided 220-kHz focused ultrasound surgery: preclinical investigation. J Neurosurg. 2015;122(1):152–161. DOI: 10.3171/2014.9.JNS14541
Open DOI Search in Google Scholar Back to article
Martínez-Fernández R, Pineda-Pardo JA, Natera-Villalba E, et al. Brain Bleeding Associated With Cavitation During Focused Ultrasound Ablation. Neurosurgery. 2025;97(5):1215–1218. DOI: 10.1227/neu.0000000000003663
Open DOI Search in Google Scholar Back to article
Giordano M, Caccavella VM, Zaed I, et al. Comparison between deep brain stimulation and magnetic resonance-guided focused ultrasound in the treatment of essential tremor: a systematic review and pooled analysis of functional outcomes. J Neurol Neurosurg Psychiatry. 2020;91(12):1270–1278. DOI: 10.1136/jnnp-2020-323216
Open DOI Search in Google Scholar Back to article
Sabet H, Abbas A, Salama EY, et al. Deep brain stimulation and magnetic resonance-guided focused ultrasound for essential tremor: a meta-analysis of effectiveness and safety. Neurosurg Rev. 2026;49(1):264. Published 2026 Mar 9. DOI: 10.1007/s10143-025-04076-x
Open DOI Search in Google Scholar Back to article
Martínez-Fernández R, Pineda-Pardo JA, Natera-Villalba E, et al. Brain Bleeding Associated With Cavitation During Focused Ultrasound Ablation. Neurosurgery. 2025;97(5):1215–1218. DOI: 10.1227/neu.0000000000003663
Open DOI Search in Google Scholar Back to article
Siu JY, Liu C, Zhou Y. High-intensity focused ultrasound ablation around the tubing. PLoS ONE. 2017;12(11): e0188206. DOI: 10.1371/journal.pone.0188206
Open DOI Search in Google Scholar Back to article
Jones J, Bolding M, Ullman H, Kaneko N, Tateshima S. Focused Ultrasound Ablation of an Arteriovenous Malformation Model. Front Neurol. 2021;12:671380. Published 2021 Jun 3. DOI: 10.3389/fneur.2021.671380
Open DOI Search in Google Scholar Back to article
Parker WE, Weidman EK, Chazen JL, et al. Magnetic resonance–guided focused ultrasound for ablation of mesial temporal epilepsy circuits: modeling and theoretical feasibility of a novel noninvasive approach. Journal of Neurosurgery JNS. 2020;133(1):63–70. DOI: 10.3171/2019.4.JNS182694
Open DOI Search in Google Scholar Back to article
Jones RM, Kamps S, Huang Y, et al. Accumulated thermal dose in MRI-guided focused ultrasound for essential tremor: repeated sonications with low focal temperatures. J Neurosurg. 2019;132(6):1802–1809. Published 2019 May 10. DOI: 10.3171/2019.2.JNS182995
Open DOI Search in Google Scholar Back to article
Yang AI, Hitti FL, Alabi OO, et al. Patient-specific effects on sonication heating efficiency during magnetic resonance-guided focused ultrasound thalamotomy. Med Phys. 2021;48(11):6588–6596. DOI: 10.1002/mp.15239
Open DOI Search in Google Scholar Back to article
Chang WS, Jung HH, Zadicario E, et al. Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull. Journal of Neurosurgery JNS. 2016;124(2):411–416. DOI: 10.3171/2015.3.JNS142592
Open DOI Search in Google Scholar Back to article
Thomas B, Bellini G, Lee WY, Shi Y, Mogilner A, Pourfar MH. High Intensity Focused Ultrasound - Longitudinal Data on Efficacy and Safety. Tremor Other Hyperkinet Mov (NY). 2025 May 5;15:18. DOI: 10.5334/tohm.987. PMID: 40351562. PMCID: PMC12063574.
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.5334/tohm.1210 | Journal eISSN: 2160-8288

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Language: English

Page range: 34 - 34

Submitted on: Mar 24, 2026

Accepted on: May 14, 2026

Published on: May 27, 2026

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

focused ultrasound,

thalamotomy,

arteriovenous malformation,

essential tremor,

case report

© 2026 Tomaima Yousef, Elma A. Chowdhury, Piush Sarkar, Hooman Azmi, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 16 (2026): Issue 1