Deep Brain Stimulation (DBS): Understanding the Implant Procedure

Most likely you will arrive at South Coast Medical Center on the morning of the surgery. You will be asked to sign a surgery consent form. Then, the first part of the procedure takes place.

The Stereotactic Frame

Dr. Duma attaches a stereotactic frame, a halo-type device, to your head. This frame stabilizes your head and helps Dr. Duma to locate the target precisely. Although local anesthetic is used to numb the areas where the frame is secured, you may feel pressure and some discomfort as it is attached.

Pinpointing the Position of the Target

Once the stereotactic frame is in place, an image of your brain will be taken using magnetic resonance imaging (MRI) or computer assisted tomography (CT). From this image Dr. Duma will check the position of the frame and take measurements to locate the position of the thalamus.

In the Operating Room

The operating room is staffed by a team of highly skilled professionals. You will see Dr. Duma, who leads the team, surgical assistants, nurses, and the anesthesiologist, who gives you anesthesia or medication and monitors your vital signs. Other team members may include a neurologist and/or a neurophysiologist, who will be involved with the testing of stimulation.

Positioning the Lead

Dr. Duma makes a small hole, about the size of a dime, in your skull. This is done while you are under local anesthetic and mild sedation. Still, you may feel some pressure. Remember the surgical team wants you to be as comfortable as possible, so always let someone know if you are uncomfortable.

He then inserts the thin lead into the thalamus or subthalamic nucleus. Since brain tissue itself does not sense pain, you most likely will not feel any pain during this part of the procedure.

Testing for Tremor Suppression/Rigidity Relief

Dr. Duma uses microelectrode recording prior to implantation. Once the lead is in place, Dr. Duma connects it to an electrical stimulator. When the stimulator is turned ON, he and the other team members evaluate the lead location and stimulation strength by seeing how well you hold a cup, or stretch your arms out and bring your fingers together, or draw spirals. You also will be asked if you feel things like numbness and tingling, and your speech will be evaluated. Depending upon your responses, Dr. Duma will adjust the lead placement and the stimulation.

If tremor cannot be suppressed or rigidity relieved or if there are side effects that cannot be controlled adequately, the lead will be removed and the procedure will not continue.

Implanting the Activa™ System

If the therapy controls your tremor during intraoperative testing, the Activa™ System will be implanted – the lead, the extension, and the pulse generator. This may occur on the same day or some days later.

For this part of the operation, general anesthesia is typically used (you’ll be asleep). The lead is secured and the pulse generator is implanted in your chest near your collarbone. The two are connected by an extension, which is threaded under your skin from the top of your head to the pulse generator. The incision in your chest skin is then closed with staples, and you are prepared for the recovery room. The system may be left OFF until the next day.

The entire procedure (from the fitting of the frame to the time you go to the recovery room) may take 2-3 hours, and implanting of the stimulator (often done on a second visit) may take 1 hour as an outpatient.