PORTLAND, Ore. (KOIN) – In a hospital room at Oregon Health and Science University, Rick Cranston rubbed his hand back and forth nervously across his newly shaven head. 

“He can pull it off! What do you think?” his wife Rabecca Cranston asked about the new haircut. 

Her husband didn’t seem so sure. He’s 74 years old and has always had a full head of hair, but thought the new ‘do was a worthy sacrifice to make for the procedure he was about to have at the hospital. 

Rick Cranston poses for a photo before his surgery at OHSU. Cranston has essential tremor, which causes his left hand to shake. In this photo, he has a full head of hair. Nurses shaved it off before his surgery to treat the tremor on March 22, 2023. (KOIN)

As Rick felt the new stubble across his skull, his left hand wobbled back and forth, the result of essential tremor, a movement disorder that causes the hand to shake uncontrollably. In a couple hours, Rick would walk out of the hospital with his hand almost as still as a statue after receiving a cutting-edge brain surgery. 

On March 22, Rick was the 31st patient to undergo the life-changing surgery at OHSU. The hospital began offering the treatment in March 2022. Rick was the final patient to receive it in the first year. 

“I know I’m not the first [to have the surgery], but I’m glad I’m one of the first. So, I’m excited, looking forward to it,” Rick said. 

The procedure is known as an MRI-guided focused ultrasound thalamotomy and while it is considered brain surgery, it doesn’t involve any incisions or dissection. Instead, Dr. Ahmad Raslan and his team direct 1,024 sonic beams through one precise part of the skull. The combined energy is enough to heat a part of the brain and create a tiny lesion in the area that’s creating the dysfunction. 

When that part of the brain is lesioned, function is restored and the shaking stops. 

A thalamotomy isn’t a new concept, but in the past they’ve been invasive or the results would be delayed, making it difficult for doctors to know if the surgery was successful. Focused ultrasound solved these problems. 

Dr. Ahmad Raslan poses for a photo in his office before performing brain surgery on Rick Cranston at OHSU on March 22, 2023. (KOIN)
Dr. Ahmad Raslan poses for a photo in his office before performing brain surgery on Rick Cranston at OHSU on March 22, 2023. (KOIN)

“It produces an immediate effect. It’s gaugeable. You can gauge how much you deliver and it’s non-invasive, so it has the best of both worlds,” explained Raslan, who’s a professor of neurological surgery at OHSU. 

Before OHSU began performing the surgery, the closest hospital to Oregon offering it was the Swedish Neuroscience Institute in Seattle

In order to be eligible for the surgery, patients must be able to show that the shaking of their hand – or hands – is severe enough to impact the quality and functions of their everyday life. 

For Rick, the shaking first began when he was about 40 years old. Over the decades, it progressed from a slight tremble to a wobble that prevented him from drinking without spilling, from writing with his dominant hand, from playing guitar and from comfortably holding his wife’s hand. 

The shaking also makes him insecure. In the hospital, he felt embarrassed as he reached for a bottle of water. 

“Other people look at me and wonder, ‘What do you have? Do you have Parkinson’s?’ Even if they don’t ask, they’re probably thinking, well, he’s got the stages of Parkinson’s or this or that, and they can see my shaking,” he said. 

Before entering the MRI room, Rick changed into comfortable clothing and medical staff fitted a stereotactic frame to his head. This holds the head in place so he can’t move as the sonic beams hit his skull. 

Rick Cranston attempts to trace a spiral, draw straight lines and right his name with his hand that shakes from essential tremor. (KOIN)
Rick Cranston attempts to trace a spiral, draw straight lines and write his name with his hand that shakes from essential tremor. Photo taken March 22, 2023 (KOIN)

They also handed him a pen and a sheet of paper. Doctors asked him to use his shaking hand to trace a spiral, draw straight lines and write his name. Rick could do little more than scribble in each section. 

Then, a nurse wheeled him down the hall. 

“Let’s get it done,” he said. 

In the MRI suite, Rick was placed inside the machine that would direct the beams to his head. Doctors and radiologists sat outside and observed images of his brain to make sure they were targeting the right location. 

Rick stayed awake through the entire process. 

Doctors increased the temperature in the area of the brain they were targeting. As they did, they would regularly check on Rick and ask him to do the spiral test and write his name. Each time was an improvement. 

After just over an hour, the procedure was done. Rick held both hands up in the air with no shaking. 

“Once they got done, and Dr. Raslan gave me the chart and the cup and everything, I could actually write my name with my left hand, that I couldn’t do before, and a spiral was 90% better than it was before and I could draw pretty much straight lines,” Rick said. 

During the procedure, Rick said he eventually felt the heat on his head and experienced some nausea and claustrophobia in the MRI room. The doctors said they could treat him with one more round, but Rick was satisfied with the results and was ready for the process to be over. 

Raslan said studies have shown 75% of patients who undergo this procedure have excellent tremor control for the next three years. If tremors ever come back, he said they can be treated again. 

Sometimes, patients have tremors in both hands. If this is the case, Raslan said they can treat one side at a time and patients should space out the procedures for each hand by a year. 

Before patients have the surgery, they must first participate in a skull density test. If a skull isn’t the right density, the procedure would be too painful. Doctors will recommend other forms of treatment if a person’s skull density can’t accommodate the surgery. 

After seeing 31 people’s lives changed in one year, Raslan highly recommends people who have essential tremor consider having the surgery. 

“It gives people back the freedom to do the simple, joyful things that they do in life,” he said. “It’s very impactful. 

Rick said the procedure feels like a blessing to him. 

“It really is a miracle,” he said. “I’m going to say it’s a miracle.”