We have analyzed 43 ventral intermediate thalamotomies performed in our center for treatment of medically intractable essential tremor (ET) in 37 patients. The mean age of patients was 70.9 years (range 42–84), duration of symptoms 33.3 years (1–65). The surgery in all cases was performed with stereotactic technique using MRI or CT localization. Intraoperative neurophysiological confirmation of the target location was obtained using a macrostimulation technique. All patients experienced either complete abolition of the contralateral tremor or significant improvement in tremor intensity immediately after the surgery. At follow-up examination 1–13 months after the operation, 60.5% of patients had no tremor, and 13.9% had mild residual tremor without interference with daily life. Tremor recurrence was observed in 5 patients, all of whom underwent repeat ventral intermedial (VIM) thalamotomy with excellent results. Transient problems with speech and motor functions were observed after 15 thalamotomies, permanent hemiparesis and speech difficulties were seen in 6 patients. We conclude that VIM thalamotomy is a highly effective procedure for medically intractable ET and may be performed with no mortality and low morbidity rate.