nitive decline or unstable gait that could be worsened by unilateral thalamotomy. Importantly, because of the skull’ s acoustic properties, patients must undergo CT screening to assess skull density ratio— a key determinant of ultrasound penetration and energy efficiency.
The advantages of MRgFUS extend beyond its non-invasive nature. Unlike DBS, there is no need for implanted hardware, reducing infection risk, maintenance and programming burden. Furthermore, patients with significant comorbidities or advanced age— often poor candidates for traditional neurosurgery— may still be eligible for MRgFUS, expanding access to interventional tremor care.
Dr. Rao also highlighted clinical outcomes, referencing data from pivotal trials showing durable tremor reduction in the majority of patients with unilateral treatment. Side effects are typically transient, including gait disturbance or paresthesia, though serious complications are rare. Long-term follow-up is ongoing, with early data supporting sustained benefit in tremor control up to three years post-treatment.
While the technology is promising, Dr. Rao was candid about its limitations. Bilateral treatment remains investigational due to concerns over speech and balance side effects. Additionally, while MRgFUS has been explored in Parkinsonian tremor and obsessive-compulsive disorder, indications beyond essential tremor are still in early stages of research and regulatory approval.
Her presentation concluded with a broader vision of functional neurosurgery in the modern era— one that balances innovation with safety, patient preference and accessibility. As one of only a handful of female neurosurgeons leading a focused ultrasound program in the U. S.,
Dr. Rao’ s role is not only clinical but transformative, contributing to the evolution of neuromodulation and lesion-based therapies.
Her return to work just two days prior to the lecture— after maternity leave— was also a meaningful reminder of the balance many physician-scientists strike between personal and professional growth. With humility and clinical clarity, Dr. Rao delivered a lecture that was both technically rich and deeply human.
For physicians seeking referral pathways or additional information, Norton Neuroscience Institute offers multidisciplinary evaluation and continues to expand access to this technology across the region.
As the field of neurosurgery enters an era of precision and personalization, MR-guided focused ultrasound stands as a striking example of what’ s possible when technology meets patient-centered care.
References
Davidson B, Lozano AM. Focused ultrasound: focused on tremor. Expert Rev Med Devices. 2025 May; 22( 5): 467-475. doi: 10.1080 / 17434440.2025.2489493. Epub 2025 Apr 17. PMID: 40184524.
Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, Schwartz M, Hynynen K, Lozano AM, Shah BB, Huss D, Dallapiazza RF, Gwinn R, Witt J, Ro S, Eisenberg HM, Fishman PS, Gandhi D, Halpern CH, Chuang R, Butts Pauly K, Tierney TS, Hayes MT, Cosgrove GR, Yamaguchi T, Abe K, Taira T, Chang JW. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med. 2016 Aug 25; 375( 8): 730-9. doi: 10.1056 / NEJMoa1600159. PMID: 27557301.
Cosgrove GR, Lipsman N, Lozano AM, Chang JW, Halpern C, Ghanouni P, Eisenberg H, Fishman P, Taira T, Schwartz ML, McDannold N, Hayes M, Ro S, Shah B, Gwinn R, Santini VE, Hynynen K, Elias WJ. Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results. J Neurosurg. 2022 Aug 5; 138( 4): 1028-1033. doi: 10.3171 / 2022.6. JNS212483.
PMID: 35932269; PMCID: PMC10193464.
This summary was generated by AI transcription software based on the live presentation delivered during the GLMS Foundation’ s Senior Physician Speaker Series. Thank you to Dr. Sam Yared for reviewing and adding insights to this summary. Final editing provided by Dr. Mary Barry.
GLMS Foundation Senior Physicians Speaker Series
Make sure to add these dates to your calendar so you don’ t miss out! August 5th | September 2nd | October 7th | December 2nd
All meetings will take place at noon via Zoom. The program is free and open to GLMS members and their guest. Please contact us for more information on the programs and how to access the meetings. Senior Physicians Committee Chair, Dr. Sam Yared, has several speakers already lined up, but is always looking for new ideas. If you have suggestions on potential speakers or topics, please reach out, we would love to hear your ideas! Missed a recent program and want to catch up? Contact us for a link to the recordings. foundation @ glms. org | 502-736-6366
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