Type of Surgery
Last updated: 11/24/2009
DBS for Parkinson's disease is considered as an option in a patient who is still responsive to levodopa (used to treat symptoms) but has developed motor complications. These include the rapid loss of benefit from a single dose (wearing off), unpredictable...
fluctuations in benefit (on-off), and uncontrolled abnormal movements (dyskinesias). Essential tremor patients who are candidates for surgery are those whose tremor is unsatisfactorily controlled by medications and whose tremor significantly impairs activities of daily living. Similar criteria apply for dystonia patients.
The patient who is a candidate for DBS discusses all the surgical options with his neurologist before deciding on deep brain stimulation. A full understanding of the risks and potential benefits must be understood before consenting to the surgery.
The patient will undergo a variety of medical tests, and one or more types of neuroimaging procedures, including MRI, CT scanning, angiography (imaging the brain's blood vessels) and ventriculography (imaging the brain's ventricles). On the day of the surgery, the stereotactic frame is fixed to the patient's head. A local anesthetic is used at the four sites where the frame's pins contact the head; there may nonetheless be some initial discomfort. A final MRI is done with the frame in place, to set the coordinates of the targeted area of the brain in relation to the frame.
The patient will receive a mild sedative to ease the anxiety of the procedure. Once the electrodes are positioned, the patient receives general anesthetic to implant the pulse generator.
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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.
Surgery for removal is generally advised for patients with limited cancer elsewhere in the body and a single brain metastasis.
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