While no real breakthrough in the medical treatment of Essential Tremor (ET) has 
recently emerged, surgical field is expanding exponentially. Purpose of this 
review is to examine the recent and future developments of the surgical 
treatments for ET. Technological advances are shaping the present and the future 
application of deep brain stimulation (DBS) in ET. New electrode configurations 
as well as new implantable pulse generators are now available. Application of 
closed-loop or adaptive stimulation in clinical practice will allow DBS to 
deliver stimulation in a truly physiological way to restore aberrant 
neurological circuits on demand, thus avoiding side effects, tolerance and also 
saving the battery life. Besides DBS and standard thalamotomy, novel surgical 
approaches for ET are on the horizon. The development of MRI-guided focused 
ultrasound technique has been the new frontier of deep brain lesional therapies. 
Although the benefit of motor cortex stimulation is yet to be defined, this 
minimally invasive approach remains intriguing. Although the advances of 
surgical treatments along the clinical and technological directions described in 
this review will certainly contribute to a successful management of ET patients, 
future studies need to consider critical issues such as the heterogeneity of ET 
and the development of tolerance.