Diffusion tensor imaging-based magnetic resonance imaging-guided focused ultrasound thalamotomy for tremor recurrence after radiofrequency thalamotomy: A case report

We report a 42-year-old, left-handed woman with tremor recurrence after radiofrequency right ventral intermediate nucleus (Vim) thalamotomy for an intractable essential tremor. The recurring tremor of the left hand disappeared on conducting magnetic resonance imaging-guided focused ultrasound (MRgFUS) right Vim thalamotomy based on diffusion tensor imaging (DTI). Referring the location of rubro-thalamic-cortical tract, we set the target medial to the prior lesion. Pre-treatment evaluation with DTI could be important for an accurate targeting and a better outcome. Furthermore, MRgFUS Vim thalamotomy could become one of the options for tremor recurrence after surgical intervention.