WHAT HAPPENS DURING DBS FOR epilepsy SURGERY?
A neurosurgeon will implant the deep brain stimulation (DBS) system in two steps. First, he or she will place the thin wires (leads) that will carry electrical signals to precise areas of the brain. Second, the surgeon will surgically place the small pacemaker-like device, or neurostimulator, under the skin in the chest or abdomen.
Depending on the surgeon's preference these steps can either be done in one day or two days over the course of a couple weeks.
The neurosurgeon will implant the following parts of the Medtronic DBS system under your skin:
- Very thin wires called leads, which deliver electrical signals from the neurostimulator to the brain
- The neurostimulator, also sometimes called a "battery" or "device", which creates the electrical pulses that help control seizures
DBS PROGRAMMER
The other components of the DBS system are not implanted, but are used to program the neurostimulator:
- The doctor will use the DBS clinician programming device to adjust the settings on the neurostimulator.
- Patients may also have a device (as shown at right) which will allow the system to be turned on and off and check the battery. Using this device, the stimulation may be adjustable within options programmed by the doctor.
BEFORE THE PROCEDURE
The doctor will give instructions about preparing for the surgery, including instructions for medications, eating or drinking before surgery, and how long they anticipate the stay in the hospital will be. A typical hospital stay for DBS surgery is one night, sometimes more.
In order to perform the procedure, the doctor may want to shave a portion or the patient's entire head. Ask the doctor what to expect for the procedure.
IMAGING AND MAPPING THE BRAIN
An MRI or CT scan will be conducted to provide the surgeon with images and maps of the brain. The doctor may attach a frame, or halo, to the head to help hold it steady during the scan. The doctor will use these images to calculate 3-dimensional coordinates of brain locations for lead placement.
PLACING THE LEADS
The neurosurgeon will place the leads first, guided by the images and maps of your brain. Unlike other DBS implant surgeries that require intraoperative test stimulation, this part of the procedure will be under general anaesthesia.
IMPLANTING THE NEUROSTIMULATOR (BATTERY)
The neurostimulator may be placed at this time, or on a different day. For this part of the surgery, this will be be under general anesthesia.
After checking that the leads are properly positioned, the surgeon will place the neurostimulator under the skin of the chest, just below the collarbone. Then the surgeon will connect the leads to the neurostimulator using extensions that run under the skin from the chest to the neck and head.
HEALING AND CARE AFTER SURGERY
Most people spend a day or two at the hospital. Healing may take several weeks. You will have pain medications for any discomfort you may have at the incision sites.
While healing, avoid strenuous activities and heavy lifting. Don't raise your arms above your shoulders, and don't bend or stretch your neck excessively. As always, follow your doctor's instructions.
Your doctor will help you decide when you're ready to return to activities and will turn your device on at your first programming session a couple weeks after your surgery.
RISKS OF THE SURGERY
DBS therapy requires brain surgery. Risks of brain surgery may include serious complications such as coma, bleeding inside the brain, stroke, seizures, and infection. Some of these may be fatal.
Once implanted, the system may become infected, parts may wear through your skin, and the lead or lead/extension connector may move. DBS therapy could stop suddenly because of mechanical or electrical problems. Any of these situations may require additional surgery or cause the symptoms to return or worsen.
Talk to the doctor about the risks that may be applicable to the specific situation.
