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A Deeper Understanding of Deep Brain Stimulation (DBS) Surgery

In DBS surgery, electrodes are placed precisely on the individual group of brain neurons responsible for movement in the affected body parts. With computer-assistance, pre-operative MRI scans and CT images taken during surgery are fused together to create a 3-D map of the patient's brain. Then, this map is overlaid with a digital brain atlas showing deep-seated structures in significant detail.

A tiny hole is carefully drilled in the patient's skull, starting the meticulous process of identifying the correct neurons inside the brain using hair-thin microelectrodes. These electrodes allow physicians to record activity so small that it can be traced to activity from one single brain cell. As the electrodes are placed, the neurosurgeon relies on the neurologist to elicit patient responses that confirm when the placements are correct. Patients must be conscious, but are kept very comfortable. Once each target in the brain is located, it is then stimulated to make sure the symptom is improved. If necessary, electrodes are moved millimeter by millimeter to gain the maximum benefits while minimizing side effects -- all while patients are still in the operating room.

While electrodes are placed on one side of the brain, the team repeats the process on the other side. The entire surgery, including both sides of the brain, typically takes about six to eight hours. CT scans are taken during or at the end of the procedure to verify exact electrode locations and rule out any side effects -- before the patient even leaves the operating room. Patients stay in the hospital overnight, and then return the following week to have the device's battery implanted under the collarbone in an outpatient procedure. After about four weeks, surgical healing is complete within the brain, and the neurologist activates and programs the DBS device to optimize the patient's symptom relief.

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