Each human brain contains billions of neurons, which communicate with one another using electrical and chemical impulses. Different regions of your brain may have less activated neurons due to a variety of brain disorders. Your brain doesn’t function as well in certain areas when that occurs. You may have disturbances in the abilities governed by the section of the brain that is injured.
DBS can alleviate the signs of several various brain diseases by increasing the activity of specific neurons using an artificial electrical current.
Before You Come For Surgery?
As the decision of DBS surgery is taken by the patient and family, consultation with a functional Neurosurgeon is a must. In difficult cases or cases where there is doubt about surgery, a TRODAT scan looking at the dopamine transport in the brain is carried out. Even a consultation with a movement disorder specialist and a neuropsychologist may be suggested. Before getting admitted to the hospital on the selected dates, about a week before the patient gets an email asking for some specific information such as:
- Is the patient taking any blood thinning medications, like warfarin, ecosprin, or clopidogrel?
- Any medical histories like hypertension, diabetes, any specific cardiac or renal disorders, or any active specific infections going on, like urinary tract infections?
- Any local scalp or chest infection?
Along with all the above information, patients need to do some routine investigations and send us the report forehand, like:
- CBC
- Serum creatinine
- Fasting and post-prandial blood sugar levels
- Urine routine examination and urine culture and sensitivity
- ECG
If the patient is a known case of hypertension, he/she has to maintain a record of his/her BP values for a week before getting admitted to the hospital and show the record to the doctor.
The patient also needs to check for any dental infections or cavities, or loose teeth, and get appropriate advice from a Dentist.
Patients need to furnish us with all the above information via mail or message to us before coming to the hospital.
In case of any blood thinners going on, patients are advised to stop the medication about 1 week before the date of surgery after consulting their Cardiologist. If there is any kind of infection in the body, patients are advised to start specific antibiotics.
In both the above scenarios, the surgery needs to be postponed if the mentioned management has not been taken appropriately.
After Getting Admitted
A group of Parkinson specialists comprising Neurosurgeons and Parkinson specialist nurses will evaluate the patient in his/her Off-medication and On-medication phases. Scoring will be done to evaluate the extent of benefits, the patient will be getting after DBS surgery.
The next day, the patient will be planned for a DBS protocol MRI which will be done with patients under general anesthesia, as this MRI takes about 40-45 mins and the patient needs to be completely immobilized during the procedure. During MRI, the patient will be carefully monitored by the anesthesia team.
Morning Of Surgery
Full head shaving with scrub head baths is given to the patients the night before surgery and on the morning of surgery.
In the operation theatre, a thorough head scrubbing will be done and under local anesthesia, the stereotactic frame will be attached to the patient’s head under monitored anesthesia care.
Patients will be then taken to the CT department and DBS protocol CT brain done along with the placement of localizer to the frame.
After CT patient will be then shifted back to the OT. The final planning of surgery will be then done by Dr. Doshi with the help of the previous day’s MRI and same-day CT brain on the navigation system.
Can I Undergo DBS Surgery If I Have Other Medical Or Surgical Issues?
DBS is a very safe procedure for various degenerative disorders and as the majority of these patients are elderly, they often have associated other co-morbidities along with Parkinson’s disease like osteoarthritis of the knee or hip, cataracts, etc. even with all these conditions, DBS can be done safely and patients get benefits in their symptoms regarding the Parkinson’s disease. The other problems can be dealt with before or after DBS and depend on the patient’s choice of what troubles them more.
How Do You Prepare For Surgery?
The benefits and drawbacks of getting a DBS device installed will be covered by your healthcare provider before this treatment. They will also go over any potential dangers associated with the procedure. They will also confirm that you can have the operation, which may entail additional imaging tests or laboratory analyses to rule out any potential contraindications.
Your healthcare Physician will next order thorough MRI and CT scans of your brain if you still decide that the DBS is what you want to have installed. These scans will aid your provider in determining where the DBS lines should be installed.
Your doctor will also go over the following with you before the procedure:
- Prescription drugs: Before your procedure, your doctor might advise you to stop taking certain drugs (such as blood thinners). Medication discontinuation should only occur following consultation with your healthcare professional. It is a good idea to ask your provider any questions you may have during these conversations about any prescription medications you are taking (including vitamins and supplements).
- Your healthcare professional will probably offer you advice on how to take a shower and get ready for the procedure. This frequently involves using a particular kind of shampoo or other things to get your skin ready for the process.
- Fasting is required because this surgery will be performed under general anesthesia. This implies no liquids or solid food for at least two hours before the surgery and no solid food for at least eight hours.
Things That Patient Should Do Or Avoid Doing To Prepare For Surgery
You will fill out papers and sign consent documents in the doctor’s office to give the surgeon information about your medical history, including any allergies, medications, anesthetic responses, and prior procedures. Several days before surgery, preoperative testing, such as blood work, electrocardiograms, and chest X-rays, may be required. To cease taking specific medications and make sure you are healthy enough for surgery, speak with your primary care physician. If you have a history of cardiac issues, your cardiologist may also need to give you the go-ahead.
Seven days before surgery, stop using any non-steroidal anti-inflammatory drugs and blood thinners. To prevent bleeding and healing issues, stop smoking and consume alcohol one week before surgery and two weeks afterwards.
Before surgery, you could be instructed to wash your skin and hair using doctor-recommended soap. Infections at surgical sites are decreased and microorganisms are killed. (Avoid getting it in the nose, genital area, eyes, or ears)
No food or drink is allowed after midnight the night before surgery, including your Parkinson’s medicine.
Get some rest the night before. The DBS procedure requires several phases and takes most of the day; you might be awake and not taking any medicine during this time.
References:
- https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation
- https://stanfordhealthcare.org/medical-treatments/d/deep-brain-stimulation/what-to-expect/before-surgery.html#:~:text=The%20evaluation%20appointment%20includes%3A,for%20surgery%20by%20a%20neuropsychologist
- https://mayfieldclinic.com/pe-dbs.htm
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