Name of the Procedure:

Twist drill, Burr Hole, Craniotomy, or Craniectomy with Stereotactic Implantation of Neurostimulator Electrode Array

Summary

This procedure involves creating an opening in the skull (via twist drill, burr hole, craniotomy, or craniectomy) to implant a neurostimulator electrode array into specific subcortical areas of the brain. These areas can include the thalamus, globus pallidus, subthalamic nucleus, periventricular region, or periaqueductal gray matter. The procedure does not use intraoperative MRI guidance.

Purpose

The primary aim of this procedure is to manage neurological disorders that are resistant to medication, such as Parkinson’s disease, essential tremor, dystonia, or chronic pain. The implanted neurostimulator sends electrical impulses to targeted brain areas to improve symptoms and enhance the quality of life.

Indications

• Persistent tremors (e.g., Parkinson’s disease, essential tremor)
• Dystonia
• Chronic pain unresponsive to other treatments
• Certain types of epilepsy
• Specific criteria include failure of medication management, significant impairment in daily activities, and overall health status that allows for surgical intervention.

Preparation

• Fasting for a specified period before surgery (usually 8-12 hours).
• Medication adjustments may be required, especially for anticoagulants or antiplatelet drugs.
• Preoperative imaging studies, such as MRI or CT scans, to map the brain structures.
• Blood tests and a thorough medical evaluation to ensure readiness for surgery.

Procedure Description

1. Preparation: The patient is positioned and their head is secured in a stereotactic frame to ensure precision.
2. Anesthesia: Depending on the specific methodology, local or general anesthesia is administered.
3. Access: A small opening in the skull is made using a twist drill, burr hole, craniotomy, or craniectomy technique.
4. Implantation: A stereotactic system guides the placement of the neurostimulator electrode array into the targeted subcortical site.
5. Closure: Once the electrodes are correctly positioned, the scalp is closed, and the externally visible hardware is secured.
6. Testing: Typically, intraoperative testing ensures the correct functioning of the device before closing.

Duration

The procedure typically takes between 4 to 6 hours, depending on the complexity and specific patient factors.

Setting

This surgery is performed in an operating room within a hospital.

Personnel

• Neurosurgeons
• Operating Room Nurses
• Anesthesiologists
• Neurosurgical Technicians

Risks and Complications

• Infection
• Bleeding or hemorrhage
• Hardware malfunction or displacement
• Stroke or other neurological damages
• Seizures
• Temporary swelling or inflammation

Benefits

• Reduction in tremors or symptoms of neurological disorders
• Improved quality of life and daily functioning
• Symptom relief can begin within days to weeks post-surgery, with full benefits potentially realized over months.

Recovery

• Initial hospital stay of around 1-2 days.
• Postoperative care includes wound care, pain management, and gradual reintroduction to normal activities.
• Follow-up appointments for device programming and adjustments.
• Full recovery typically spans a few weeks to months, with activity restrictions based on individual progress.

Alternatives

• Continued medical management (medications).
• Other surgical interventions (e.g., lesioning procedures like pallidotomy or thalamotomy).
• Pros and cons: Medications may have limited efficacy or side effects, while other surgical options may not offer the same level of symptom control.

Patient Experience

• During the procedure, the patient might experience minimal discomfort due to anesthesia and positioning.
• After the procedure, there might be mild to moderate pain at the surgical site, manageable with prescribed pain relievers.
• The patient will need assistance and care during the initial recovery phase, with attention to wound care and physical activities limitations. Regular follow-ups will ensure optimal device programming and symptom relief.