For which patients do you consider stereotactic radiosurgery rather than focused ultrasound for treatment of essential tremor?

Stereotactic radiosurgery (SRS) thalamotomy has a very limited role in my practice. Although SRS can provide meaningful tremor reduction and is an option for patients who are not candidates for DBS or MR-guided focused ultrasound (MRgFUS), I only consider it in highly selected circumstances, primari...

One might consider stereotactic radiosurgery rather than focused ultrasound when the patient's Skull Density Ratio (SDR) is below 0.30. That said, favorable results can be obtained in patients with an SDR <0.30, although less predictably. The obvious alternative to stereotactic radiosurgery is the t...