A CLOSER LOOK AT DBS SURGERY DBS Therapy for Parkinson’s Disease

WHAT HAPPENS DURING DBS FOR PARKINSON’S SURGERY

A neurosurgeon will implant the 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 place the small pacemaker-like device, or neurostimulator, under the skin of your chest.

Depending on your surgeon's preference these steps can be either done in one day or two days over the course of a couple weeks.

The neurosurgeon will implant the following parts of your DBS system under your skin:

• Very thin wires called leads deliver electrical signals from the neurostimulator to the brain
• The neurostimulator, also sometimes called a "battery" or "device", that creates the electrical pulses that help control movement symptoms of Parkinson's, including tremor, slowed movement, and stiffness

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. For this part of the surgery, you will be awake so you can confirm that the leads are placed in the best location to control your movement symptoms. Though you will be awake, you will not feel pain.

The surgeon may ask you to move your arms or legs, tap your fingers, move your hands, or pretend to drink from a cup, then stimulates an area of the brain to test results.

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.