What does surgery for deep brain stimulation (DBS) involve?

During deep brain stimulation, (DBS) leads are implanted during three separate and staged surgeries. During the first surgery, a lead is placed in one side of the brain; during the second surgery another lead is placed in the other side of the brain, and during the third surgery, batteries (generators) are implanted.

Surgeons must find the precise target location in your brain to implant a deep brain stimulation device (DBS). Because individual brains are shaped differently, special tools and techniques must be used to locate and access the specific brain structure where the implant will go, without disturbing the surrounding structures.

A stereotactic frame is a tool that is generally used in delicate brain surgeries. It is a metal structure that holds a patient's head quite still, to give the doctors a starting point for making measurements.

Surgeons also often use sophisticated imaging techniques to help them find the precise location of specific structures within the brain. Such imaging techniques include magnetic resonance imaging (MRI) and computerized tomography (CT) scans, which can be likened to three-dimensional X-rays.

Dr. Nader Pouratian, MD

During deep brain stimulation (DBS) surgery, the doctor strategically places electrodes in your brain. A battery-powered generator, implanted in your chest, gives out continuous pulses of electricity that correct abnormal patterns of brain activity.

The surgery is most commonly done as an asleep-awake-asleep procedure. That means you will be give anesthesia and be asleep at the start of the procedure. Then, after the doctor enters your brain, you will be awakened so you can respond to verbal commands.

Afterward, you will be put to sleep again as the final stage of the operation is completed. Since there are no pain receptors in the brain, you will feel no discomfort while you are awake during the operation.

This content originally appeared online at UCLA Health.

Surgery is done to set up deep brain stimulation (DBS) treatment. Medicine is given that makes people go to sleep, so they won’t feel anything during surgery. Sometimes this medicine comes as a liquid that goes in through a small tube in the back of the hand or wrist. Cream is put on the skin first so the person hardly feels the tube at all. The doctors may first need to cut the hair very short. This may be a small patch of hair or more.

The doctor then makes a couple of small holes in the skull to put small wires through. The doctor will take pictures of the brain from the outside and use computers to make sure the wires go in exactly the right place. Once the wires are in place, doctors may take more pictures to check their position. The wires are hidden under the skin and connected to a small machine called a neurostimulator which sits on the chest just under the skin. Once this is all set up, the person wakes up from surgery. A person might feel a bit sore, but medicines can help. The neurostimulator sends out the electrical signals that go through the wires to the brain. It can be set to different strengths and it will be programmed to make sure it’s right for the person.

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