What a DBS Neurosurgeon Wants You to Know
25
Surgery
Ajmal Zemmar , MD , PhD , gives a glimpse of what happens behind the scenes with surgery for DBS . A physician-scientist and neurosurgeon , Dr . Zemmar practices at University of Louisville Health , Louisville , Kentucky .
What ’ s the one thing you want people and families with Parkinson ’ s to know about DBS surgery ?
“ Brain surgery ” sounds scary , but drilling a hole is one of the simplest , safest and least invasive procedures in neurosurgery . But for the patient , these fears are very natural . I always address them with the patient so that fear doesn ’ t take over . I would advise patients and families to talk it through beforehand with a surgeon — and also ask other patients how they felt afterwards . The majority of them will tell you , “ It ’ s nowhere near what I thought brain surgery would be .”
What is the most common fear expressed by patients , and how do you address that ?
Patients are concerned with what it means to be awake while someone is operating on their brain , but that aspect of the surgery is usually much less bothersome than other aspects , such as being in one position for three to four hours . I always set expectations beforehand and work with the patient to ensure they ’ ll be comfortable . I say , “ I am there with you the entire time . Whatever bothers you , tell me and we will fix it . We are working as a team .”
What should people discuss with their surgeon before deciding to have the surgery ?
They need to think , “ It ’ s my body , it ’ s my surgery . The surgeon will help me to get through it , but ultimately this is about me .” They need the confidence to expect answers to all their questions , an idea of all the details , the pros , the cons , the benefits , the expectations , the side effects and the risks . If they walk out of the consultation feeling that the surgeon didn ’ t address their questions or didn ’ t let them talk , it ’ s going to make them nervous . Maybe it ’ s not a good fit . Patients always have the choice to say , “ Okay , I ’ m trying someone else .”
How do you prepare families before the procedure ?
I outline all the steps : anesthesia , surgery — three to four hours — and then I ’ ll come to visit them while the patient is recovering . They may be separated from their loved one for eight hours , but that doesn ’ t mean that the surgery itself takes eight hours . It ’ s the job of the neurosurgeon to create a comfortable environment . Letting everyone know that I am grateful for their trust puts the focus where it belongs : on the patient , not the physician .