Deep Brain Stimulation

Your surgeon will work with you to plan a procedure that gives you the best chance of achieving your goals while minimizing any pain and discomfort. There are many different technologies and options for doing the procedure in a way that fits your preferences. Surgery can be done awake or asleep. It can be done all in one day or broken up into stages several days or even weeks apart.

Placement of the DBS lead

The goal of the operation is to place, within millimeter accuracy, 1 or 2 DBS electrode leads deep inside the brain. The successful outcome depends critically upon accurate targeting. The first step of the operation is attachment of the targeting device, a metal frame, or other device, to the patient’s skull at several points. Parts of this procedure are sometimes done awake under local anesthesia. It is not painful but some patients do complain of pressure or headache afterwards. This can also be done asleep.

Next, the patient undergoes a short brain imaging scan, a CT scan. The calibrations on the targeting device are merged with the brain image to form a computerized map of the brain. This map becomes the blueprint for planning and measuring the trajectories of the electrode leads into the deep brain regions.

Next, while the patient is asleep, the surgeon next makes a small opening in the top of the skull to create a passageway for the insertion of the stimulating electrode into the brain. As an additional means to ensure the accuracy of lead, the surgeon and team may perform electrical brain mapping during surgery. This technique uses tiny electrodes that can record electrical activity from individual brain cells within deep brain regions. These “microelectrodes” are much smaller and more delicate than the electrodes that provide the deep brain stimulation. They are used to identify cells within the deep brain targets and adjacent structures and help steer the main probe towards the desired surgical target.

Depending on what was discussed and planned before surgery, the patient may then be woken up from anesthesia. The surgeon and neurologist may ask the patient to make certain movements or ask questions about he or she is feelings and what symptoms he or she is experiencing. The patient is kept comfortable with light anesthesia during this part of the procedure. When testing is complete, the patient then goes back to sleep while the surgeon finishes the procedure. The accuracy of the lead position is confirmed with another brain imaging scan.

Surgical Stages

Depending on each patient’s needs and preferences, sometimes two DBS leads are implanted in the same operation; at other times, they are staged over two operations that are weeks or months apart. Sometimes, the surgeon places the entire apparatus– DBS lead, connecting wire, and implantable pulse generator (IPG, ie. the battery)–in a single day. Other times the surgeon first performs the DBS lead insertion and delays the rest of the work to a second procedure the following week. Some individuals prefer the idea of stages procedures so they can recover between steps, while others “just want to get it over and done.”