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William McK. & Marcia N.Thompson Center for Restorative Neurosurgery
Patient Care
DBS in Photos
Perhaps the most common DBS procedure, STN DBS is considered in cases of advanced, medication-responsive Parkinson’s disease. In the procedure, electrodes are placed into the STN, an area of the brain approximately the size of an almond, in regions of high neuronal activity and responsiveness. In addition, a generator is attached to the electrodes and placed in the chest.
STN DBS with Head Frame
Below are photos of a subthalamic nucleus deep brain stimulation procedure. In this case, the surgery was performed with a head frame in place.
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1. A head frame is first centered upon the patient’s head. Four screws (two in front, two in back) are placed to fix the position.
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2. With the frame in place, a CAT Scan of the head is performed. From these images, the neurosurgeon and neurologist map out the location of the stimulator’s target (STN, GPI, thalamus) in the brain.
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3. After shaving a small section of the forehead, the head frame is clamped to the operating bed. Not only does this ensure that the patient’s head remains still, but it is from these braces that the neurosurgeon will use the measurements to place the electrodes.
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4. A small hole about the size of a nickel is drilled into the skull. Using the predetermined measurements, the micro-thin test wire is slowly moved to the target location.
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5. With the test wire in place, neurologists use measurements of pulse width and frequency of cell firings to determine the most responsive location for the permanent electrode.
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6. Once the exact location has been determined, the neurosurgeon places the permanent stimulation wire before plugging the small hole in the skull and stitching up the incision.
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7. The incision is cleaned and bandaged. Slight sedatives and numbing agents are used during the more invasive points during the surgery. However, the patient is fully awake and able to communicate what sensations or side effects they are experiencing during stimulator placement. Though this may sound scary, there is no pain sensation in the brain, and therefore, the patient is able to help determine the best placement for the electrodes without any discomfort!
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8. Once bandaged, the surgery is over and the patient is taken to recovery. In most cases, the patient is ready to return home the following day. Two or three weeks later, the patient returns for the stimulators to be turned on for the first time.
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