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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