Name of the Procedure:

Implantable Neurostimulator Electrode
Common Names: Neurostimulator Electrode Placement, Brain Stimulator Electrode Installation
Technical/Medical Terms: L8680 - Implantable Neurostimulator Electrode, each

Summary

This procedure involves the implantation of tiny electrodes in the brain or spinal cord to deliver electrical impulses. These impulses modulate neural activity, potentially alleviating symptoms of various neurological conditions.

Purpose

Medical Conditions or Problems it Addresses:

• Chronic pain
• Epilepsy
• Parkinson’s disease
• Essential tremor
• Dystonia
• Cluster headaches

Goals or Expected Outcomes:

• Reduction in symptom severity
• Improved quality of life
• Decreased reliance on medications

Indications

Symptoms or Conditions:

• Medically refractory epilepsy
• Severe, intractable pain unresponsive to conservative treatment
• Motor symptoms in Parkinson’s disease not adequately controlled by medication
• Incapacitating tremors

Patient Criteria:

• Failure to respond to conventional treatments
• Clear diagnosis of a suitable neurological condition
• Psychological readiness and informed consent for undergoing the procedure

Preparation

Pre-Procedure Instructions:

• Fasting typically required 8-12 hours before surgery
• Medication adjustments, especially blood thinners
• Discussions with a physician about current medications and health status

Diagnostic Tests:

• MRI or CT scans for surgical planning
• Blood tests to check overall health
• Neurological assessment to tailor electrode placement

Procedure Description

1. Anesthesia: General anesthesia or local anesthesia with sedation
2. Incision and Access: Small incision made through the skull, or into the spinal area
3. Electrode Placement: Precise placement of electrodes into the targeted brain or spinal cord areas using specialized instruments and imaging guidance (such as MRI or CT)
4. Connection: Electrodes are connected to an internal pulse generator, which is usually implanted under the skin in the chest or abdomen
5. Testing and Adjustment: Initial testing of the electrical impulses for therapeutic effect
6. Closure: Incisions are closed with sutures or staples

Duration

Typically lasts between 3-6 hours, depending on complexity and individual patient factors.

Setting

Performed in a hospital setting, typically in an operating room equipped with specialized neuroimaging facilities.

Personnel

• Neurosurgeon
• Anesthesiologist
• Operating room nurses
• Neurologist (for intraoperative testing and adjustment)

Risks and Complications

Common Risks:

• Infection
• Bleeding at the surgical site
• Pain or swelling at the implantation site

Rare Complications:

• Electrode misplacement
• Device malfunction
• Neurological deficits (e.g., speech or motor issues)
• Cerebrospinal fluid leak

Benefits

• Significant reduction in symptoms
• Improved motor function and daily living activities
• Enhanced quality of life, often noticeable within weeks

Recovery

Post-Procedure Care:

• Hospital stay of 1-3 days for monitoring
• Wound care instructions
• Gradual return to normal activities over weeks

Expected Recovery Time:

• Most patients recover within 4-6 weeks, with gradual improvements in symptoms
• Follow-up appointments for programming and adjustments of the stimulator

Alternatives

Other Treatment Options:

• Medication adjustments
• Physical therapy
• Non-invasive neuromodulation (e.g., TENS units)
• Surgical interventions such as lesioning surgeries or radiosurgery

Pros and Cons:

• Non-invasive options have fewer risks but may be less effective for some conditions
• Surgical alternatives may be more suitable for patients who cannot undergo electrode implantation

Patient Experience

During the Procedure:

• Anesthesia ensures patients do not feel pain during surgery
• Some patients might undergo awake procedures for real-time symptom monitoring

After the Procedure:

• Initial discomfort at the implantation site
• Gradual adjustment to the neurostimulator’s effects
• Pain managed with prescribed medications and comfort measures such as ice packs or rest