Before the Procedure

During your initial evaluation, you see a team of specialists who determine if DBS is the right treatment for you. An important way to determine if DBS will help is to evaluate you both when you are taking medication and off medication.

You will receive medication instructions before your appointment. For example, if you have essential tremor, you may need to gradually stop using medication. If you have Parkinson’s disease, you may take extra medication one day and no medication the following morning.

The evaluation may include:

• A brain MRI and CT scan
• Comprehensive assessment by a neurologist
• Computerized balance testing
• Physical and emotional readiness assessment for surgery by a neuropsychologist

After your evaluation, the team meets to discuss your case and possible risk factors. If DBS surgery is right for you, you will have a follow-up visit with a neurosurgeon. During the visit, the neurosurgeon answers your questions and discusses surgical options and risks. After the discussion, you decide together whether to pursue surgery.

Additional appointments before your surgery include:

• A meeting with your anesthesia team and an anesthesiologist
• A presurgical medical history intake
• A physical exam

During the Procedure

DBS involves two separate surgeries to place the DBS leads and the generator.

Lead placement
We use the most advanced techniques to implant DBS leads. During surgical lead placement:

1. Your neurosurgeon numbs your scalp. Depending on your procedure, you may receive a sedative to remain relaxed but awake during the operation, or you may be put to sleep.
2. Your neurosurgeon makes a small incision about 2.5 centimeters long on one or both sides of your head. Then they create one or two dime-sized openings in your bone called burr holes. They insert the leads through the burr holes.
3. Your surgeon uses advanced technology called microelectrode recording to “listen” to your brain cells as they insert the lead. This allows them to pinpoint exactly where the lead should go in your brain.
4. Your neurologist will move your arms and legs and the team listens to the response from your brain cells. They test stimulation for any side effects. This helps your neurosurgeon ensure the leads are positioned correctly to maximize symptom control and minimize side effects.
5. Your neurosurgeon places the back end of the leads behind your ear, underneath your scalp.

It takes about two to three hours to place leads in both sides of the brain. Your surgery may be shorter if your surgeon is only placing leads in one side of your brain. You’ll spend one night in the hospital after lead placement.

Neurostimulator placement
Typically this procedure will be several days to a few weeks after the first procedure.

During neurostimulator placement:

1. You receive general anesthesia that puts you in a sleep-like state.
2. Your surgeon makes an incision near your collarbone and places the generator in your upper chest.
3. Your surgeon makes another incision behind your ear where they placed the back end of the lead. Then they implant extension wires that pass beneath the skin of your neck and scalp to connect the generator to the brain leads.

Neurostimulator placement is an outpatient procedure, meaning you can return home the same day. It usually takes about 30 minutes.  

After the Procedure

You return to the neurology clinic about one month after surgery to begin your DBS programming visits. During the programming visit, your neurologist evaluates you and programs the neurostimulator. We monitor your movements to help determine the correct settings and intensity for the stimulator.

You see your team again regularly to help optimize your treatment. During these visits, we may gradually increase the settings on your neurostimulator. Eventually, we may reduce your medications.
 

Caring for your device
You will receive an identification card from the company that manufactures the deep brain stimulator to carry with you at all times. Present the card if you are in a situation that might affect the device.

Most electrical devices will not harm the DBS system. These systems are MRI compatible, though you should let your care team know that you have a DBS system beforehand.

Do not have any of the following procedures on skin or tissue directly over the stimulator:

• Electrocautery
• Electrolysis
• Radiation
• Ultrasound

Accidentally deactivating the stimulator will not harm you. However, any symptoms that the device controlled or eliminated will return. Your doctor will give you a hand-held device to turn the stimulator back on, if it is accidentally deactivated.