Cutting-Edge Solutions for Tremor: RF Thalamotomy and Deep Brain Stimulation

Cutting-Edge Solutions for Tremor: RF Thalamotomy and Deep Brain Stimulation

After years of medication trials, increasing doses, and struggling with side effects, many essential tremor patients find that drugs offer little consolation. Drinks spill, signatures falter, and everyday actions become restricted.

At this point, modern neurosurgery offers two powerful solutions: Radiofrequency (RF) Thalamotomy and Deep Brain Stimulation (DBS – Brain Pacemaker).

Although intervening in the millimeter-scale source of tremors deep in the brain may seem daunting or like something out of science fiction, in the hands of Assoc. Prof. Dr. Mehmet Sorar, these procedures are carefully planned routines.

The Thalamus: The Brain’s Control Center

The thalamus is the brain’s central hub for sensory input and motor commands. In essential tremor, a small nucleus called VIM (Ventral Intermedius Nucleus) sends faulty, rhythmic signals to muscles.

Both RF Thalamotomy and DBS target this nucleus, aiming to stop or modulate the abnormal signals, restoring smoother movement.

Radiofrequency (RF) Thalamotomy

An older yet reliable technique, RF Thalamotomy is permanent and especially suited for severe tremor in one hand.

How It’s Performed

• The patient is awake under local anesthesia.
• The head is fixed with a stereotactic frame.
• CT and MRI fusion identifies the millimeter-precise VIM nucleus.
• A hair-thin electrode is advanced carefully, avoiding other brain areas.
• Physiological verification ensures the electrode is in the correct spot. Low electrical current tests whether tremor stops.
• Once confirmed, RF energy creates a controlled lesion about the size of a rice grain.

Pros and Cons

Pros: No implants, one-time procedure, no battery maintenance or infection risk, usually lower cost.
Cons: Usually unilateral. Bilateral procedures increase risk of speech, swallowing, and balance issues. Permanent and irreversible.

Deep Brain Stimulation (DBS): Adjustable Brain Pacemaker

DBS is modern, adjustable, and reversible, ideal for bilateral tremors, head or voice involvement, and younger patients.

How It Works

• Awake, local anesthesia procedure.
• The VIM nucleus is located but not lesioned.
• Electrodes are implanted under the skin and connected to a generator (battery) under the collarbone.
• The battery sends adjustable electrical impulses to normalize abnormal brain activity, reducing tremor.

Advantages

• Adjustability: Settings can be changed externally if tremor worsens or side effects occur.
• Bilateral application: Both hands can be treated simultaneously.
• Reversibility: Future therapies can override or remove the system without permanent tissue damage.

During Surgery: Immediate Feedback

The most impressive part of stereotactic surgery is real-time results. The patient is awake and can test movement.
Dr. Sorar communicates constantly. Test stimulation allows patients to see tremor reduction before the surgery ends—for example, lifting a cup or performing precise hand movements.

Frequently Asked Questions (FAQ)

Q: Will I feel pain during surgery?
A: No. Brain tissue has no pain receptors. Only the scalp receives local anesthesia, causing minor discomfort like a mosquito bite.

Q: Will my hair be shaved?
A: Usually not. Only small entry points are shaved, with minimal impact on appearance.

Q: Will the DBS battery be visible?
A: No. It is placed under the chest muscle or subcutaneous fat. Slight bulge possible in very thin patients, but not visible under clothing.

Q: How long does the surgery take?
A: RF Thalamotomy: ~1–1.5 hours. DBS (bilateral): 3–4 hours.

Entrust Your Brain and Future to Skilled Hands

Handing over the control center of your existence—the brain—is a monumental decision. Dr. Mehmet Sorar approaches this responsibility with utmost care.

In his operating room, the patient-doctor hierarchy gives way to teamwork and precision, ensuring safety, effectiveness, and your regained independence.

With Dr. Sorar, you are not just a patient—you are a collaborator in reclaiming your life from tremors.