Simultaneous combined unilateral ventralis intermedius (VIM) thalamotomy and contralateral VIM deep brain stimulation for head tremor: A case report

Abstract

Head tremor usually requires bilateral deep brain stimulation of ventralis intermedius nucleus of thalamus. Ablation of VIM nucleus (VIM thalamotomy) is applied for limb tremor unilaterally because of serious complications from bilateral thalamotomy. Therefore, effects of thalamotomy on head tremor have been rarely reported. We report a successful long‐term outcome of head tremor with combined unilateral VIM thalamotomy and contralateral VIM‐DBS simultaneously. The patient was a 49‐year‐old man with head and bilateral hand tremors. His Fahn‐Tolosa‐Marin Tremor Rating Scale scores (head tremor score, range 8‐0, higher scores indicate greater severity) before and after the surgery were 8 and 0, respectively. Only transient tongue numbness was confirmed as a surgical complication. At the final follow‐up (36 months), the patient was completely free from tremor of the head and bilateral hands. Combined thalamotomy and DBS can be an alternative treatment option for head tremor.