Deep Brain Stimulation Surgery
If the patient wishes to proceed with surgery, and is determined to be a good candidate based on review of evaluation findings by the neurosurgeon, surgery will be scheduled.
These videos take the viewer through the stages of the DBS surgery, starting with the neurosurgeon working at the back of the patient's head. The videos include shots of microelectrode recording and interpretation by the neurologist to determine the best location in the brain to place the stimulator leads.
The microelectrodes are test stimulated to look for improvement in symptoms as well as side effects such as tingling, tightening, mood changes, or flashing lights. In these videos, the tremor stops once the stimulator is activated at the correct settings. An intra-operative scan is then obtained. This shows the location of the electrodes in the brain. Based on all of the information, the team decides on the best location and the lead is inserted in the chosen track.
Once the lead is activated, the tremor stops and the patient says "Happy Birthday"! The lead is secured in place and the positioning device is removed.
The team works with the patient and family to accommodate schedules for the surgery and is experienced working with people traveling from locales outside of Richmond.
Equipment Used for Deep Brain Stimulation Surgery at VCU
The surgical technique used by the VCU team utilizes frameless stereotaxy, microelectrode recording, and test stimulation to place the deep brain stimulator lead in the best possible location within the brain.
Frameless stereotaxy uses six small screws or fiducials to replace the bulky metal frame used in Frame stereotaxy. These are placed during surgery while the patient is sedated and removed at the end of surgery. The patient is able adjust his/her position to get comfortable during the surgery.
Frameless positioning system used in DBS surgery at VCU.
Example of frame traditionally used in DBS surgery.
Day of Surgery
All Parkinson's and Essential Tremor medications are stopped at midnight the night before surgery.
The nurse will review where to report and what time the morning of surgery.
On the day of surgery, the patient is positioned comfortably in the operating room with his/her head and neck resting on a cervical support which is attached to the table. The front of the collar is used to secure the patient while asleep but is removed once fully awake and conscious.
The patient is sedated while six small bone screws or fiducials; skin incision(s) and a burr hole or dime-size hole in the skull; is made. The patient is awakened and recording begins. The device used to hold and advance the microelectrode is attached directly to the burr hole allowing the patient to adjust his/her head position if needed to be more comfortable.
Once the microelectrode recording is completed, test stimulation is performed to determine efficacy and side effects. The microelectrode may need to be moved if there is little improvement or if there are troubling side effects. Moving the electrode is done through the same burr hole. Once an optimal location is found, the actual DBS lead is inserted and secured into place. This process is repeated for the other side of the brain for those patients undergoing bilateral stimulator placement.
The battery and extensions are placed several days later in a separate procedure, under general anesthesia after the patient has fully recovered from the intracranial surgery. Unilateral lead placement surgery is shorter and less tiring, and the battery and extension are generally placed on the same day as the DBS lead.
Most patients with unilateral stimulators are discharged from the hospital the day after surgery. Patients who have bilateral leads placed may require a longer hospital stay (one to five days). Patients who are in poor health before surgery will recover more slowly and may require a prolonged stay in the hospital or rehabilitation facility.
Patients who have an elevated blood pressure in the recovery room or other surgical complications will be admitted to the ICU. All others will go to a regular room.
Patients may choose to stay in the VCU Gumenick suites at an additional cost. These suites offer private rooms and spacious adjoining suites with additional nursing care and a private chef.
Accommodations for Those Outside Richmond
For those patients who may be traveling from outside of Richmond for DBS evaluation and surgery, there are several area hotels that offer special rates for VCU patients.
Make an Appointment
Please call (804) 360-4669 to schedule an appointment.