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.