23
For many, surgery is, understandably, the scariest part of DBS. Any type of surgery naturally raises emotions and fears. Brain surgery can raise them even more. To feel as prepared as possible, learn as much as you can, get answers to all your questions, and make sure you’ re comfortable and confident with your surgeon and DBS team.
There are two main steps to DBS surgery: 1) placing wire( s) in the brain and 2) placing the battery, also called a neurostimulator or implantable pulse generator( IPG), in the chest or abdomen. Extension wires connect brain wires to the battery. Most of the time, the brain wires and battery are placed during two or more separate procedures.
No matter which DBS device you get or where you have surgery, the basics are the same. But the details and timing can differ from medical center to medical center and from surgeon to surgeon. leads in the right location. If this makes travel too difficult, you might be allowed a small dose. Make sure to discuss this with your doctors and make a plan.
If you live far from the DBS center, consider staying nearby in a hotel or with loved ones the night before. Surgery day is long enough without extra travel time, especially when off medication.
+ Frame placement Your surgeon positions a temporary metal frame on the outside of your head. This is secured to the skull with small pins, after numbing each site with medication. The frame keeps your head still while leads are placed. Some surgeons use a“ frameless” system, which involves a small head-mounted tower that guides the wire to the right spot. This requires an additional clinic visit about a week before surgery to place screws in the skull and take measurements for building the tower.
Surgery
Brain Wire Placement
Thin wires, also called leads or electrodes, are placed into one or both sides of the brain, in areas that control movement. Some people get one lead in each side of the brain during the same procedure. Others wait a few weeks between the first and second lead placement. This could be to make sure certain symptoms, like memory changes, don’ t worsen, or because that’ s the way the surgeon and the center operate. Sometimes, a person gets only one lead, perhaps because they have severe tremor only on one side. Rarely, over time, a person might end up with more than one lead in each side of the brain, based on their response to DBS, symptoms and disease progression.
Here’ s what lead placement entails:
+ Skipping medication The morning of surgery, you won’ t take Parkinson’ s or tremor medications. This is so your doctors can see your symptoms and get
+ Brain imaging Before the surgery, an MRI and CT of the brain are done. This imaging acts like a GPS system for your surgeon, so they know where to put the electrodes. Right after surgery and during your hospital stay, a CT scan is usually done to ensure correct lead placement. Another CT scan may be done when you later follow up with your surgeon, to make sure there are no complications, but this varies from center to center.
+ Hair shaving In most cases, the surgeon will shave some or all of your hair. This is so you can adequately care for the incisions and limit infection risk. Ask how much hair will be shaved before the procedure so you know what to expect. If you prefer not to shave your hair, ask your surgeon whether this is possible.
Lead implantation You receive numbing and sedating medications that keep you comfortable but don’ t put you all the