What happens during Deep Brain Stimulation Surgery?
The whole procedure lasts 5 to 7 hours when the electrodes are inserted into the brain. In general, the surgery lasts 3 to 4 hours.
Attach stereotactic frame
The operation is conducted stereotactically, which allows a frame to be fixed to your head. The frame is momentarily placed on your head with Velcro straps when you are sitting. With local anesthesia, the four-pin sites are injected to alleviate pain. As the pins are close, you can feel some strain.
MRI or CT scan
Using either computerized tomography (CT) or magnetic resonance imaging, you can then have an imaging scan (MRI). Placed over the top of the frame is a box-shaped localizing unit. On the scan, markers in the box turn up and help define the exact three-dimensional coordinates within the brain of the target region. To design the electrode trajectory, the surgeon uses MRI / CT images and special computer software.
Skin and skull incision
They will take you to the operating room. You will lie on the table and you will be able to protect the stereotactic head frame. When placing the electrodes, this avoids any slight movements of the brain. During the process, you will stay awake. During the initial skin incision, mild sedation is provided to make you more relaxed but then stops so that you can speak to the doctors and perform tasks.
The hair along the incision line is shaved about an inch high. To show the brain, a skin incision is made across the top of your head. Two quarter-sized burr holes on the left and right sides of the skull are made using a drill (Fig 3). These holes cause the brain to move through the electrodes.
Insert electrode in the brain
A recording electrode is inserted into the brain through a small opening. The electrode is implanted to a specific depth and angle within the brain based on measurements from the MRI / CT scans and the planning machine. No pain is felt by the brain itself, so you do not feel any discomfort.
The accuracy of the positioning of electrodes is verified by a variety of studies. You may be asked to lift or count numbers on your arms or legs. The surgical team will listen to the right nerve cells as well. The recording electrode will hear the firing of the brain cells and show on a screen the waveforms. The most time-consuming part of the treatment is this. For both the left and right sides of the brain, it must be repeated. The surgical team will do their job with your patience and cooperation.
stimulate the brain cells
The surgeon replaces the recording electrode with a permanent DBS electrode/lead until the exact nerve cells are found. Stimulation monitoring is performed. You will be asked whether you believe any of your symptoms are lessening or going away entirely.
A plastic cap is positioned over the burr hole to keep the lead in place until the team is pleased with the electrode placement. For later connection to the extension wire and the stimulator, a coil of wire is left under the scalp. With sutures or staples, the scalp incision is closed and a bandage is applied.
The cost of Deep Brain Stimulation Surgery in Lagos is as following:
| Surgery name
|A minimum price (Naira)
|Maximum price (Naira)
|Average price (Naira)
|Deep Brain Stimulation
The Cost for Brain Stem Surgery may vary according to the following factors:
- Doctor’s Fee
- Hospital charges
- Medical condition after Deep Brain Stimulation Surgery
- Type & Quality of Implants/Consumables
- Lab Tests recommended post-Deep Brain Stimulation Surgery
What happens after Deep Brain Stimulation Surgery?
You may immediately take your daily dose of Parkinson’s medication after surgery. For tracking and observation, you are held overnight. The next day, most patients are released back home.
You may feel better than normal during the recovery period after implanting the electrodes. A lesion effect that lasts from a few days to weeks is caused by brain swelling around the electrode tip. Once the stimulator is inserted and programmed, this transient effect is a strong indicator of the result.
You will return to the hospital for outpatient surgery about a week later, to insert the stimulator in the chest/abdomen. Under general anesthesia, this surgery is done which takes about an hour. For patients who are going home you may immediately take your daily dose of Parkinson’s medication after surgery. For tracking and observation, you are held overnight. The next day, most patients are released back home.
Implant the stimulator
With general anesthesia, you will be taken to the OR and put to sleep. To access the leads, a part of the scalp incision is reopened. Near the collarbone, a small incision is made, and the neurostimulator is inserted beneath the skin. An extension wire that passes under the skin of the scalp, down the spine, to the stimulator/battery in the chest or abdomen is connected to the lead. The system can be visible under the skin as a slight bulge, but normally it is not seen under clothing.
As the incisions heal, you can avoid arm movements over your shoulder and unnecessary stretching of your neck. With medicine, discomfort at the incision sites may be controlled.
program the stimulator
Around 10 days after the service, an office visit will be arranged for you. The stimulator will be programmed and it will change the dosage of your drug. For up to 12 hours before the programming session, you may be asked to avoid taking your drugs. This is achieved in order to improve the programming’s efficacy in reducing the normal symptoms. It is important that you work to change the drugs and improve the programming with the neurologist and nurse. For programming, you can return to the office every 3 weeks. In order to achieve optimum symptom regulation while reducing side effects, it usually takes 3 to 4 programming sessions.