Although I have performed 1,000+ gamma knife procedures, gamma knife thalamotomies are not very commonly performed. We tend to perform deep brain stimulation or stereotactic lesions since they have been found to be more advantageous. However, occasionally, patients are felt to not be good candidates for the other procedures and undergo gamma knife radiosurgery thalamotomy. Contralateral weakness is a known risk for all these procedures. This case will hinge on whether or not there were reasons why the patient needed to undergo gamma knife and avoid an open operation for DBS or stereotactic thalamotomy. Any information indicating whether the technique used as a violation of the standard of care will also be helpful.