DEEP BRAIN STIMULATION

How is Deep Brain Stimulation (DBS) Surgery Performed?

How is Deep Brain Stimulation (DBS) Surgery Performed?

Deep Brain Stimulation (DBS) is a sophisticated surgical procedure employed to treat certain neurological conditions, particularly Parkinson's disease, Essential tremor, and Dystonia. As an advanced therapeutic option, DBS has yielded remarkable improvements in motor functions and quality of life for many patients. This page provides a comprehensive overview of the steps involved in DBS surgery.

Preoperative Phase

The journey toward successful DBS surgery begins with meticulous preoperative preparation. This stage is crucial for ensuring that the procedure is tailored to the patient's unique anatomical and neurological profile.

MRI Under General Anesthesia:

The process commences with obtaining high-resolution magnetic resonance imaging (MRI) scans, typically enhanced with contrast agents. This imaging is conducted under general anesthesia to ensure precision and patient comfort. The MRI provides detailed visualization of brain structures, aiding in the accurate identification of surgical targets.

The accurate placement of electrodes is crucial as it directly impacts the results. To achieve this, we need clear visualization of the brain's structures, which necessitates obtaining detailed and high-quality images. Therefore, we perform imaging under general anesthesia. This technique enhances our accuracy and improves our outcomes.

Additionally, to visualize all vascular structures of the brain, we use contrast-enhanced MRI images. This allows us to identify all vessels and chart a safe path that avoids them, significantly reducing the risk of bleeding to a minimal level.

Stereotactic Frame Mounting

Under local anesthesia, a stereotactic frame is affixed to the patient's head. This frame serves as a reference system, enabling precise navigation during the surgery. The frame ensures that subsequent imaging and surgical steps are executed with exactitude. We do not implant the electrodes directly into the brain by hand. Instead, we use a frame that allows us to achieve precise measurements down to a tenth of a millimeter. This ensures that the surgery is performed with high sensitivity and accuracy. To determine where to implant the electrodes, we need to create a detailed plan, calculate the coordinates, and determine the trajectory angle. The planning of the DBS electrodes will be discussed in the next paragraph.

Acquiring CT Images

With the stereotactic frame in place, computed tomography (CT) images are obtained. These images offer complementary data to the MRI scans, enhancing the accuracy of targeting within the brain. The synthesis of MRI and CT data is imperative for planning the electrode implantation.

Targeting, Planning, and Coordinate Determination

Using the combined MRI and CT images, Neurosurgeons meticulously plan the trajectory for electrode implantation. Advanced software is employed to determine the optimal coordinates for electrode placement, ensuring that the targeted brain regions are reached with precision.

Perioperative Phase

We can divide DBS surgery into two parts. The first part involves implanting the electrodes, preferably under local anesthesia or light sedation, and verifying their position using a CT scan. The second part involves implanting the pulse generator under general anesthesia.

We can perform these two stages either on the same day or on separate days, depending on the patient's overall condition and the outcome of the first stage of the surgical process..

Electrode Implantation

The electrode implantation phase can be carried out under local anesthesia or sedation, or general anesthesia. In our center to have the best result we prefer to do it under local anesthesia or light sedation, because we want to test the electrode placement and during this test the patient must be awake or light sedated. In our center, we do not place the electrode directly on the target initially. Instead, we insert several electrodes into different spots within a 2 mm diameter area. We then send test signals through these electrodes and evaluate the patient's symptoms, asking questions about both the beneficial and side effects they might experience. Additionally, we ask the patient to perform specific tasks or respond to stimuli. This process helps us determine the optimal electrode placement tailored specifically for each patient. However, if the patient cannot stand or prefers local anesthesia for this stage, we can proceed with general anesthesia while still performing the necessary tests.

During electrode implantation, we utilize a C-Arm to ensure precise placement of the lead. Once the electrodes are in place, the incisions are carefully closed.

Checking Electrode Position by CT

Subsequent to electrode placement, a follow-up CT scan is performed to verify the precise location of the electrodes. This ensures that the electrodes are accurately positioned within the intended brain regions, maximizing therapeutic efficacy and minimizing potential complications.

Implanting the Implantable Pulse Generator

The final phase of DBS surgery involves implanting the Implantable Pulse Generator (IPG). The IPG, commonly referred to as a neurostimulator, is a compact device placed subcutaneously, typically near the clavicle. It is connected to the electrodes via extension leads and delivers programmed electrical impulses to the targeted brain regions, modulating neural activity to alleviate symptoms. This phase is performed under general anesthesia to ensure the patient experiences no discomfort or pain. The second stage, involving the implantation of the pulse generator, can be postponed to a later date based on the patient's overall condition.

Conclusion

Deep Brain Stimulation (DBS) surgery represents a groundbreaking approach to managing complex neurological conditions such as Parkinson's disease, dystonia, and essential tremor. By meticulously following each procedural step and adhering to stringent protocols, neurosurgeons ensure optimal outcomes for their patients. The benefits of DBS are profound, offering significant symptom relief, improved quality of life, and reduced dependency on medications. While potential risks exist, they are relatively rare and can be managed with appropriate medical oversight.

For individuals considering DBS surgery, consulting with a specialized medical team is essential to fully understand the procedure, its benefits, and any associated risks. If you are interested in exploring DBS as a treatment option, please reach out to our experienced team at our Neuromodulation Center in Istanbul, Turkey for expert guidance and consultation.