J Neurosurg 145:27–35, 2026
This multicenter retrospective cohort study evaluates unilateral MR-guided high-intensity focused ultrasound (MRgHIFU) thalamotomy targeting the ventral intermediate nucleus (VIM) for medically refractory essential tremor in patients aged 80 years and older. Results from 129 patients show marked reductions in tremor and disability scores, high patient-reported relief, and generally mild, transient adverse events.
Age-stratified analyses found comparable tremor benefit across 80–84 and ≥85 year groups, modest gait changes, and low rates of serious complications, supporting MRgHIFU as a noninvasive therapeutic option for elderly patients ineligible for deep brain stimulation.
Objective Evaluate safety and efficacy of unilateral MRgHIFU thalamotomy targeting the VIM for medication-refractory essential tremor in patients aged ≥ 80 years.
Design Retrospective, multicenter cohort of consecutive patients treated between 2016 and 2023 at five academic centers, with assessments at baseline, immediately posttreatment, and 3 months.
Primary outcome Tremor severity measured by TETRAS; primary endpoint was change from baseline to follow-up.
Efficacy In 129 patients (mean age 84), mean TETRAS improved by 9.2 points at 3 months (p < 0.001), with significant improvement also seen on CRST and mean patient-reported tremor relief of 81%.
Gait effects DGI gait scores improved modestly overall but were not significant in the ≥ 85 years subgroup.
Safety Adverse events were generally mild/transient; nonsurgical adverse events occurred in 1.6% of patients.
Age-stratified results Treatment response and adverse event profiles did not significantly differ between ages 80–84 and ≥ 85 years.
Conclusion Unilateral MRgHIFU VIM thalamotomy provides a low-complication, noninvasive option that significantly improves tremor and disability in adults aged ≥ 80 years, supporting consideration for those ineligible for invasive procedures like DBS.
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