11
Focused Ultrasound (FUS) Gamma Knife Surgery (GKS)
Ablation: uses multiple ultrasound beams
to destroy tissue in the brain.
Ablation: uses multiple radiation beams
to destroy tissue in the brain.
VIM nucleus of the thalamus VIM nucleus of the thalamus
Awake Awake
Immediate Weeks to months
• No hole in the skull
• No device implanted in body
• Does not require frequent follow-up
• May be an option for patients with
comorbidities and unable to undergo
DBS
• Staged bilateral procedures that must be
at least 9 months apart
• No hole in the skull
• No device implanted in body
• Does not require frequent follow-up
• Unable to adjust to increase benefit
or reduce side effects without
further surgery
• Not reversible
• Must be able to tolerate MRI
• Head fully shaved
• Pre-existing cognitive issues could
worsen
• Unable to adjust to increase benefit
or reduce side effects without
further surgery
• No bilateral procedures
• Not reversible
• Long-term complications may develop
as effects of radiation spreads
• May take months to see an effect
• Pre-existing cognitive issues could
worsen
35–75% tremor reduction (unilateral)
60–80% (staged bilateral)
• Rarely used in ET
• 3–60% tremor reduction (unilateral)
Edema, headache, paresthesia, weakness,
nausea, dysarthria, gait disturbances
Edema, scalp irritation, headache, fatigue,
nausea, weakness, dysarthria, confusion
