Name of the Procedure:

Twist Drill, Burr Hole, Craniotomy, or Craniectomy with Stereotactic Implantation of Neurostimulator Electrode Array in Subcortical Site (e.g., Thalamus, Globus Pallidus, Subthalamic Nucleus, Periventricular, Periaqueductal Gray) with Use of Intraoperative Guidance

Summary

This procedure involves surgically implanting an electrode array into deep brain structures to manage neurological conditions. Using precise imaging and stereotactic techniques, electrodes are accurately placed into specific subcortical areas to stimulate and regulate brain activity.

Purpose

This surgery is primarily conducted to treat movement disorders such as Parkinson’s disease, essential tremor, and dystonia. The goal is to reduce symptoms, improve motor function, and enhance the quality of life for patients by modulating abnormal brain activity.

Indications

• Severe, medication-refractory Parkinson’s disease
• Essential tremor not responsive to medication
• Dystonia with inadequate response to pharmacotherapy
• Chronic pain syndromes
• Certain psychiatric disorders (as determined by a specialist)

Preparation

• Fasting for at least 8 hours before the procedure
• Medication adjustments as advised by the healthcare provider
• Preoperative imaging studies (MRI or CT scans)
• Neurological assessment and consultations with the surgical team

Procedure Description

1. Patient Positioning and Anesthesia: The patient is positioned in a stereotactic frame, and general or local anesthesia is administered.
2. Imaging: Intraoperative imaging (MRI or CT) is used to map the brain and precisely target the area for electrode placement.
3. Surgical Access: A small incision is made, and a tiny burr hole is drilled into the skull.
4. Electrode Placement: Stereotactic guidance ensures accurate implantation of the neurostimulator electrode array into the targeted subcortical site.
5. Testing and Adjustment: Intraoperative testing confirms correct placement. Adjustments are made to optimize electrode positioning.
6. Closure: Incisions are closed and dressed after securing the electrode leads.

Duration

Typically lasts between 4 to 6 hours, but duration can vary depending on individual patient circumstances.

Setting

The procedure is performed in a hospital operating room equipped with advanced imaging technology.

Personnel

• Neurosurgeon
• Surgical nurse
• Anesthesiologist
• Neurophysiologist
• Radiologist (for intraoperative imaging)

Risks and Complications

• Infection at the surgical site
• Bleeding or hemorrhage
• Adverse reactions to anesthesia
• Neurological deficits (e.g., weakness, speech problems)
• Device-related issues (e.g., malfunction, displacement)

Benefits

• Significant reduction in symptoms of movement disorders
• Improved motor control and daily functioning
• Potential reduction in medication usage and side effects
• Long-lasting improvement in quality of life, often noticeable shortly after recovery

Recovery

• Initial hospital stay of 1-2 days for monitoring
• Gradual return to normal activities within 2-4 weeks
• Follow-up appointments for device adjustment and monitoring
• Pain management typically includes over-the-counter analgesics and prescribed medications

Alternatives

• Medication management (often less effective in advanced cases)
• Physical therapy and rehabilitation
• Other surgical interventions (e.g., Ablative surgery)
• Each alternative has its own benefits and risks, and none are typically as effective as this procedure in severe, refractory cases.

Patient Experience

During the procedure, patients may experience minimal discomfort due to anesthesia. Postoperatively, some soreness at the incision site is expected. Patients generally report significant symptomatic relief and improved quality of life following recovery, with pain and discomfort managed effectively by the surgical team.