Type of Surgery
Last updated: 11/24/2009
Deep brain stimulation relies on implanting a long thin electrode deep into the brain, through a hole in the top of the skull. In order to precisely locate the target area and to ensure the probe is precisely placed in the target, a "stereotactic frame"...
is used. This device is a rigid frame attached to the patient's head, providing an immobile three-dimensional coordinate system, which can be used to precisely track the location of the GPi or STN and the movement of the electrode.
For unilateral DBS, a single "burr hole" is made in the top of the skull. Bilateral DBS requires two holes. A strong topical anesthetic is used to numb the skin while this hole is drilled. Since there are no pain receptors in the brain, there is no need for deeper anesthetic. In addition, the patient must remain awake in order to report any sensory changes during the surgery. The electrode is placed very close to several important brain structures. Sensory changes during electrode placement may indicate the electrode is too close to one or more of these regions.
Once the burr hole is made, the surgeon inserts the electrode. Small electric currents from the electrode are used to more precisely locate the target. This is harmless, but may cause twitching, light flashes, or other sensations. A contrast dye may also be injected into the spinal fluid, which allows the surgeon to visualize the brain's structure using one or more imaging techniques. The patient will be asked to make various movements to assist in determining the location of the electrode.
The electrode is connected by a wire to an implanted pulse generator. This wire is placed under the scalp and skin. A small incision is made in the area of the collarbone, and the pulse generator is placed there. This portion of the procedure is performed under general anesthesia.
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In neurotechnology, deep brain stimulation (DBS) is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. DBS in select brain regions has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders such as chronic pain, Parkinsonâ€™s disease, tremor and dystonia. Despite the long history of DBS, its underlying principles and mechanisms are still not clear. DBS directly changes brain activity in a controlled manner, its effects are reversible (unlike those of lesioning techniques) and is one of only a few neurosurgical methods that allows blinded studies.
The Food and Drug Administration (FDA) approved DBS as a treatment for essential tremor in 1997, for Parkinson's disease in 2002, and dystonia in 2003. DBS is also routinely used to treat chronic pain and has been used to treat various affective disorders, including major depression. While DBS has proven helpful for some patients, there is potential for serious complications and side effects.
Select comparative data from 1999 to 2006 include a decrease of 14 percent in the number of neurosurgeons in private practice and a decrease of 13 percent in the number of neurosurgeons in solo practice.
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