                
|
A patient undergoing the implatation of a deep brain stimulator(DBS) is
admitted one day prior to the scheduled day of surgery. All anti-parkinsonian
medications are withheld from 10pm on the day of admission until after
the surgery. This is done to maximize our ability to observe the benefit
of the placement of the DBS, as well as to minimize drug-induced dyskinesias
that could make being in a headframe more difficult.  In the morning, a patient is taken to the radiology suite for placement of a stereotactic head frame. We utilize the Leksell (Elekta) frame to allow us to precisely target in an X,Y,Z plane of the structure being localized (STN, GPi, or Vim). Following sterilization of the forehead and occiput, the patient is given a local anesthetic prior to attaching the frame. Patients are fully awake during such placement, which takes less than 15 minutes, and most patients tolerate the placement of the frame without any difficulty.  click on images to enlarge
 After completion of the initial targeting in radiology, the patient is taken to the operating suite where the head frame is fixed to the top of the operating table. The position of the patient is adjusted to a reclining fashion so that the patient is comfortable for the next few hours. After shaving a small amount of hair (always behind the hairline), the area is cleaned and sterile drapes are placed. Once again, local anesthetic is applied to the scalp prior to making a small, two inch linear incision. Next, a dime-size 14mm burr hole is drilled in the skull under the anesthesized scalp. Patients are fully awake during the drilling and compare the experience to being at the dentist. Patients rarely feel any pain during this part of the procedure. Next, the covering of the brain (dura) is opened, and we are ready for what we believe is the most critical step to local our final target: the "gold standard", microelectrode recording (MER). |
