Deep Brain Stimulation

One of the more impressive advances in neurosurgery is placement of deep brain stimulators (DBS). Electrodes are placed in specific parts of the brain and electrical impulses can be sent through a generator. This has been pretty successful in medication-resistant Parkinson's disease, chronic pain, tremor, dystonia, and even depression. While much of neurosurgery deals with anatomic problems, this is a functional approach that seeks to treat disorders by altering brain signals and impulses.

The placement of DBS electrodes is a pretty involved multidisciplinary affair. A 60 year old man with severe Parkinson's disease despite multiple medication trials presents for DBS electrodes placement. I bring him back to the operating room and minimize the medications I give because I don't want to interfere with intraoperative neurologic testing. I administer a low dose propofol drip while the surgeons drill holes into the skull where the electrodes will be placed. Then, after the brain is exposed, we wake the patient up. With enough local anesthetic, the patient tolerates this quite well. Because of the underlying rigidity and tremor from Parkinson's disease, a massage therapist attends to the patient's comfort. As the neurosurgeons place the electrodes, a neurologist does serial exams. As the electrodes get closer to the right location, the tremor diminishes, the joints become more flexible, and the patient's symptoms improve. A PhD and severe technicians are in charge of the electronics. And of course we have a circulating nurse and a scrub nurse as well. Once the electrodes are in the right place, we have the patient go back to sleep as the surgeons close. Other than the local anesthetic, very little pain medication is given. It's a large affair that requires the right patient who can tolerate being awake during a brain surgery.

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