Streamlining deep brain stimulation surgery by reversing the staging order

Journal of Neurosurgery
Craig G van HorneGreg A Gerhardt

Abstract

Deep brain stimulation (DBS) is approved for several clinical indications; however, the sequencing of DBS surgery and the timeline for implementing stimulation therapy are not standardized. In over 140 cases so far, the authors have reversed the sequencing for staged implantation of DBS systems that was conducive to minimizing patient anxiety and discomfort while providing the opportunity to shorten the time between implantation and programming for therapeutic management of symptoms. Stage I was performed with the patient under general anesthesia and consisted of implantation of the pulse generator and lead extensions and placement of the bur holes. Stage II was completed 1-7 days later, using only local anesthesia, and included stereotactic frame-based microelectrode recordings, semi-microstimulation and macrostimulation, and testing and placement of the stimulating electrodes. Stage I lasted approximately 90 minutes, whereas Stage II lasted approximately 230 minutes. All patients tolerated the procedures and received a complete implanted system. Deep brain stimulation therapy was typically initiated on the same day as lead implantation. When sequencing was reversed and bur holes were placed during the first stage while a pati...Continue Reading

References

Apr 12, 2002·Movement Disorders : Official Journal of the Movement Disorder Society·Anthony E Lang, Hakan Widner
Jul 1, 2006·Movement Disorders : Official Journal of the Movement Disorder Society·Ali R RezaiAlim-Louis Benabid
Dec 17, 2008·Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons·Kazuhiro MurakamiTadaaki Kirita
Nov 17, 2012·Stereotactic and Functional Neurosurgery·Aviva AboschMarwan I Hariz
Feb 12, 2013·Neuron·Andres M Lozano, Nir Lipsman

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Methods Mentioned

BETA
sedation

Software Mentioned

IPlanStereotaxy
Brainlab intraoperative
VectorVision2
neuronavigation

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