Conventional, surgical thalamotomy is an invasive procedure where the target ( the Vim of the thalamus) is surgically destroyed (ablated). Neurosurgeons use specialized probes inserted deep into the brain to precisely locate the treatment target. Like DBS surgery and the Neuravive procedure, the patient is usually awake, and the area on the scalp where the surgical tools are inserted is numbed with an anesthetic. Different methods can be used to kill the brain cells, including radio-frequency heating or cooling with a special probe. As an invasive surgery to access the brain, thalamotomies pose inherent risks, such as infection and bleeding in the brain.
Additional information about these treatment options is available at https://www.essentialtremor.org/treatments/ and https://www.webmd.com/brain/essential-tremor-stereotactic-thalamotomy.