• Francesca Valentino, Giuseppe Cosentino, Rosario Maugeri, Roberto Giammalva, Gerardo Domenico Iacopino, Maurizio Marrale, Tommaso Vincenzo Bartolotta, and Cesare Gagliardo.
• Neurology Unit, Department of Biomedicine, Neurosciences & Advanced Diagnostics, University of Palermo, Palermo, Italy.
• Oper Neurosurg (Hagerstown). 2020 Jun 1; 18 (6): 577-582.

IntroductionIn recent years, transcranial Magnetic Resonance Imaging-guided Focused Ultrasound (tcMRgFUS) treatments for functional neurological disorders are giving a new thrust to the field of therapeutic brain lesioning.ObjectiveTo present the case of a patient affected by tremor combined with Parkinsonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremor after a few months from the first tcMRgFUS treatment.MethodsA 72-yr-old, right-handed man, came to our observation because of a disabling tremor affecting his upper limbs, refusing any invasive surgical procedure and already treated by tcMRgFUS left Vim thalamotomy. However, clinical benefit had brief duration, as a progressive recurrence of tremor on the right upper limb was observed after a few months from the first treatment. Thus, the patient underwent a new left-sided tcMRgFUS procedure 6 mo after the former treatment.ResultsAfter the second procedure, an immediate and complete relief from tremor on the right upper limb was achieved with clinical benefit that persisted up to a 6-mo follow-up.ConclusionSince tcMRgFUS doesn't use ionizing radiations and it is incision-less, repeated and staged treatment procedures have always been hypothesized. Our report suggests that tcMRgFUS retreatment might actually be a feasible, safe, and effective option in selected patients in whom an optimal clinical outcome is not achieved after the first treatment session. However, future well-designed studies in large samples are needed to assess the possible risks of retreatment and the optimal timing of reintervention as well as eligibility and exclusion criteria.Copyright © 2019 by the Congress of Neurological Surgeons.

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