Name of the Procedure:

Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays.
Common name(s): Neurostimulator implantation, Cranial stimulator surgery

Summary

This procedure involves placing or replacing a device in the skull that sends electrical signals to the brain. These signals can help manage certain neurological conditions by altering brain activity. The device is connected to multiple electrode arrays placed in specific brain regions.

Purpose

The procedure addresses various neurological conditions like chronic pain, movement disorders (e.g., Parkinson's disease), epilepsy, and certain mental health conditions. The goal is to reduce symptoms, improve quality of life, and enhance daily functioning.

Indications

• Chronic, untreatable pain
• Parkinson's disease or other movement disorders
• Epilepsy that does not respond to medication
• Certain psychiatric disorders, such as major depression
• Candidates typically have not found relief through other treatments

Preparation

• Pre-procedure fasting as directed by the medical team
• Medication adjustments, especially for blood thinners or other critical medications
• Diagnostic tests such as MRI or CT scans to map brain areas
• Comprehensive health assessment including blood work and cardiac evaluation

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A scalp incision is made for access to the skull.
3. Craniotomy: Small sections of the skull are removed to reach the brain.
4. Electrode Placement: Electrode arrays are inserted into specific brain regions identified by pre-procedure imaging.
5. Device Insertion: The neurostimulator pulse generator or receiver is implanted beneath the skin (typically near the collarbone).
6. Connection: Wires are tunneled under the skin from the device to the electrode arrays.
7. Testing: The system is tested for proper function before closing the incision.
8. Closure: Incisions are closed with sutures or staples.

Duration

Typically, the procedure takes about 2 to 5 hours, depending on its complexity.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses and technicians
• Neurologist (in some cases)

Risks and Complications

• Infection at the incision site
• Bleeding or swelling in the brain
• Device malfunction or failure requiring further surgery
• Seizures or changes in neurological function
• Cerebrospinal fluid leakage
• Pain at the implantation site
• Rare risk of stroke

Benefits

• Reduction in symptoms associated with the neurological condition
• Improved quality of life and functional ability
• Benefits can often be realized within weeks of the procedure

Recovery

• Hospital stay for monitoring, usually 1 to 3 days
• Post-operative pain management with prescribed medications
• Follow-up appointments for device programming and adjustments
• Activity restrictions: Avoid heavy lifting and intense activity for a few weeks
• Gradual return to normal activities as advised by the medical team

Alternatives

• Medication management
• Non-invasive brain stimulation techniques (e.g., Transcranial Magnetic Stimulation)
• Surgical interventions like deep brain stimulation without multiple electrode arrays
• Each alternative comes with its own pros and cons, varying effectiveness, and side effects

Patient Experience

• During the procedure: The patient is under general anesthesia and will not feel pain or be aware of the surgery.
• After the procedure: Expect soreness and mild pain at incision sites, manageable with pain medications.
• Device adjustments might be necessary, typically done in follow-up visits.
• Gradual improvement in symptoms over days to weeks, depending on the condition being treated.