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 your brain. Second, the surgeon will surgically place the small pacemaker-like device, or neurostimulator, under the skin in the chest or abdomen.
Depending on your 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 your 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 your neurostimulator:
- Your doctor will use the DBS clinician programming device to adjust the settings on your neurostimulator.
- You may also have a device (as shown at right) which will allow you to turn the system on and off and check the battery. Using this device, you may be able to adjust the stimulation within options programmed by your doctor.
BEFORE THE PROCEDURE
Your doctor will give you instructions about preparing for your surgery, including instructions for medications, eating or drinking before surgery, and how long they anticipate you will be staying in the hospital. A typical hospital stay for DBS surgery is one night, sometimes more.
In order to perform the procedure, your doctor may want to shave a portion or your entire head. Ask your doctor what to expect for your procedure.
IMAGING AND MAPPING THE BRAIN
You will have an MRI or CT scan to provide your surgeon with images and maps of your brain. Your doctor may attach a frame, or halo, to your head to help hold it steady during the scan. Your doctor will use these images to calculate 3-dimensional coordinates of brain locations for lead placement.
PLACING THE LEADS
Your 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 (Parkinson’s disease and essential tremor), you will be placed under general anesthesia during this part of the procedure.
IMPLANTING THE NEUROSTIMULATOR (BATTERY)
The neurostimulator may be placed at this time, or on a different day. For this part of the surgery, you will be under general anesthesia.
After checking that the leads are properly positioned, your surgeon will place the neurostimulator under the skin of your chest, just below the collarbone. Then your surgeon will connect the leads to the neurostimulator using extensions that run under the skin from the chest to your 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. Medtronic DBS therapy could stop suddenly because of mechanical or electrical problems. Any of these situations may require additional surgery or cause your symptoms to return or worsen.
Talk to your doctor about the risks that may be applicable to your specific situation.
