Eight patients with medically refractory disabling essential tremor underwent ventralis lateralis (VL) thalamotomies; the procedure was unilateral in seven cases and bilateral (staged) in the other. Contralateral tremor remained absent or markedly reduced in all patients at the time of the most recent follow-up examinations, at a mean of 17.3 months after surgery. Disability was determined by a modified form of an established rating scale for tremor, and was reduced from a mean score of 21.1 (moderate grade) to 3.9 (absent grade) (p less than 0.001). Interestingly, voice tremor was abolished or significantly improved in 71.4% of patients with preoperative voice tremor. This feature has not been reported previously. Persistent surgical morbidity was limited to two patients with mild dysarthria and one with a mild cognitive impairment. There were no surgically related deaths. It is concluded that stereotactic VL thalamotomy is a treatment option for medically intractable disabling essential tremor.