Deep Brain Stimulation Surgery While Asleep

Standard DBS surgery is performed while you are awake. In 2011, Dr. Kim Burchiel developed a new method of implanting DBS  electrodes to treat Parkinson disease and essential tremor, under general anesthesia (while asleep), using a CereTom TM intraoperative computed tomography (CT) scanner.


What happens during asleep DBS surgery?

There are two stages:

Stage 1 (The procedure takes 4-5 hours and involves an overnight stay)

Surgical planning of the placement of the DBS electrodes takes place under general anesthesia (while asleep). While laying on the surgical table, the DBS patient’s head is placed in a CereTomTM head frame and intraoperative images are taken inside a CT scanner. These images are fused with high nuclear resolution 3T MR images obtained twenty-four hours before surgery.

A small opening (bur hole) is made in the skull and the DBS electrode is precisely placed using the fused images as a guide. Areas of the brain where the electrodes are generally placed: the thalamus, the subthalamic nucleus, or the globus pallidus.

A second set of intraoperative CT images are obtained to ensure the DBS electrodes have been placed accurately. Electrode adjustments are made if needed. After confirming that the DBS electrodes are in the correct place, the DBS leads are tucked to one side of the head in preparation for attachment to the generator device, which will be placed under the collarbone.

When the procedure is finished, the patient is moved to the neurosciences neurointensive care unit for observation overnight. After recovery, patients go home with wound care and postoperative instructions.

Stage 2 (A week later, this procedure takes about 45 minutes for each electrode and is done in the clinic)

The electrodes are connected via the extension wire to the internal pulse generator (IPG), which is usually located in the chest (near the collarbone).

Once the implanted system is switched on (about 30 days after surgery), continuous low-voltage electrical pulses are sent from the IPG up along the extension wire and the lead and into the targeted brain area.  Doctors are not sure exactly how the electrical pulses work, but they appear to interfere with the abnormal nerve signals and/or change the brain chemicals that cause the tremors and other movement disorder symptoms.