The research focus and frontiers in surgical treatment of essential tremor.
Authors: Zhang L, Cui S, Bi H, Chen Q, Kan M, Wang C, Pu Y, Cheng H, Huang B
Essential tremor (ET) is one of the most prevalent neurodegenerative disorders, with surgery serving as the principal treatment option. This paper presents a bibliometric analysis of research in the field of ET surgery from 2004 to 2024, aiming to identify current research hotspots and inform future research directions. This study employs CiteSpace to analyze publication trends, countries/institutions, authors, keywords, and co-cited references in ET surgery, using the Web of Science core database from 2004 to 2024 to delineate the research pathways. A total of 1,362 publications were included in this study. The number of publications has shown steady growth over the analyzed period from 2004 to 2024. Research in this field was carried out in 58 countries and by 371 institutions. The United States had the highest volume of publications, with the University of California System identified as the most prolific institution. Dr. Michael S. Okun from the University of Florida was the most prolific author, also based in the United States. This study identified 879 keywords, with significant citation bursts noted in areas such as the caudal zona incerta, ventral intermediate nucleus, location, and MR-guided focused ultrasound. Among the top ten highly cited articles, five pertained to MR-guided focused ultrasound thalamotomy, two addressed localization techniques, and one focused on surgical targets. This study employs comprehensive bibliometric and visualization analyses to elucidate the evolution of research and identify emerging hotspots. The identified hotspots are as follows: First, deep brain stimulation (DBS), the most advanced technology in ET surgery, has room for improvement, especially in neuromodulation automation. Second, MR-guided focused ultrasound thalamotomy is a new surgical approach that requires further research on efficacy, safety, and side effect management. Third, novel surgical targets have demonstrated some efficacy, yet further research is essential to validate their effectiveness and safety. Lastly, localization techniques are fundamental to ET surgery, with ongoing efforts directed towards achieving more precise, individualized, and intelligent localization.
Introduction
Purpose
Thermal ablation
Study Objective
To perform a bibliometric analysis of research on essential tremor surgery from 2004 to 2024 to identify current research hotspots and inform future research directions.
Disease model
Essential tremor
MRI or image guidance method
MR-guided (Magnetic Resonance-guided focused ultrasound)
Targeted brain region(s)
Ventral Intermediate Nucleus
Outcomes and Safety
Summary of Outcomes
This bibliometric analysis found growing research on surgical treatments for essential tremor, highlighting DBS as the most established and effective long‑term therapy (bilateral VIM DBS reported tremor reductions of ~66–78%) and MR‑guided focused ultrasound (MRgFUS) thalamotomy as an effective minimally invasive alternative (≈47% improvement in hand tremor scores at 3 months maintained to 12 months); novel targets (PSA, cZI) show mixed or variable efficacy and precise localization remains critical. The paper did not test focused ultrasound parameters itself and reports no specific sonication parameters as being tested or identified as successful.
Duration of biological effect
12 months
Safety-related matter
The paper repeatedly highlights safety and adverse-effect concerns: MR-guided focused ultrasound (MRgFUS) needs further study on efficacy, safety and side-effect management with acute adverse reactions depending on target location/size and patient factors (e.g., bone density, intracranial metal, cognitive/psychiatric issues); cZI DBS may cause cerebellar/motor side effects (unsteadiness, incoordination), while PSA vs VIM DBS showed no differences in the overall quality or quantity of side effects but PSA-related stimulation had more prominent emotional/behavioral disturbances. The authors note DBS generally minimizes risk of permanent damage compared with ablative procedures and call for more long-term, large-sample studies of safety and side-effect management.
Brain Region
Ultrasound Parameters
Focal Characteristics
Focal depth: None; Focal length: None; Aperture size: None
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