Stage 1: Implantation of the electrodes in the brain. This entire process takes around 5-7 hours.
Step 1
Attaching the stereotactic frame In this procedure, while you are seated, a frame is positioned temporarily on your head with Velcro straps. The four-pin sites are injected under local anesthesia to minimize discomfort.
Step 2
Computed tomography (CT) or magnetic resonance imaging (MRI) scan You will have an imaging scan, either MRI or CT. A device (box-shaped) is placed over the top of the frame, and markers in the box show up on the scan and help to pinpoint the exact three-dimensional coordinates of the target area within the brain. The surgeon uses CT/MRI scans and special computer software to plan the placement of the electrode.
Step 3
Skin and skull incision Now at this step, you will be taken to the operating room and lie on the table. The stereotactic head frame will be secured. This will prevent any movements of your head while inserting the electrodes. Light sedation will be given to make you comfortable during the initial skin incision and then stopped so that the surgeon can talk to you and perform tasks. Your hair will be shaved about an inch wide along the incision line, and an incision is made over the top of your head to expose the skull. Using a drill, two holes are made on the right and left sides of the skull, which allow the electrodes to be passed through the brain.
Step 4
Insert electrode in the brain Through these small holes, a recording electrode is inserted into the brain. Based on calculations from the CT/MRI scans and the planning computer, the electrode is inserted to a precise angle and depth inside the brain. The precision of the electrode placement is confirmed by various tests.
Step 5
Brain cells stimulation Once the exact nerve cells are detected, the recording electrode is replaced with a permanent DBS electrode/lead by the surgeon. Test stimulation is performed. You will be asked if you feel that any of your symptoms lessen or completely gone.
Step 6
Closure When the team is satisfied with the placement of the electrode, a plastic cap is placed over the hole to keep the lead in place. A coil of wire is left under the scalp for attachment to the extension wire and the stimulator. The scalp incision is closed with help of staples or sutures, and a bandage is applied Post-surgery, you may take your regular dose of medicine for Parkinson's immediately. You will be kept under observation and monitoring. Usually, most patients are discharged home the next day. During the recovery phase, after implanting the electrodes, you may feel better than normal.
Stage 2: A week later, you will return to the hospital for implanting the stimulator in the chest/abdomen. This surgical procedure is performed under general anesthesia and takes about an hour. The patient can return home the same day.
Step 7
Implant the stimulator You will be taken to the operation theatre and put to sleep with the help of general anesthesia. The scalp incision is reopened to have an access to the leads. Near the collarbone, a small incision is made, and under the skin, the neurostimulator is implanted. The lead is then attached to an extension wire which is passed under the skin of the scalp, down the neck, to the battery/stimulator in the abdomen or chest. The device will be visible as a small bulge under the skin but usually not seen under clothes. While the healing of the incision is in process, avoid arm movements over your shoulder and excessive stretching of your neck. Pain at the incision sites can be taken care of with medication.
Step 8
Program the stimulator About ten days post-surgery, you will be requested to visit the doctor, where the programming of the stimulator is done, and your medication dosage will be adjusted. You may be suggested to stop your medications for up to 12 hours before the programming session. You will return to the visiting doctor every three weeks for programming. It typically takes 3-4 programming sessions to attain maximum symptom control while minimizing side effects. Most patients don't feel the stimulation as it reduces their symptoms. However, some patients may feel a brief tingling sensation when the stimulator is first turned on. It's important to remember that Parkinson is a disease that is progressive, and symptoms get worse over time. Patients have to visit the neurologist's office from time to time to adjust the stimulation settings.
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