TY - JOUR
T1 - Streamlining deep brain stimulation surgery by reversing the staging order
AU - Van Horne, Craig G.
AU - Vaughan, Scott W.
AU - Massari, Carla
AU - Bennett, Michael
AU - Asfahani, Wissam S.Z.
AU - Quintero, Jorge E.
AU - Gerhardt, Greg A.
N1 - Publisher Copyright:
© AANS, 2015.
PY - 2015/5
Y1 - 2015/5
N2 - Deep brain stimulation (DBS) is approved for several clinical indications; however, the sequencing of DBS surgery and the timeline for implementing stimulation therapy are not standardized. In over 140 cases so far, the authors have reversed the sequencing for staged implantation of DBS systems that was conducive to minimizing patient anxiety and discomfort while providing the opportunity to shorten the time between implantation and programming for therapeutic management of symptoms. Stage I was performed with the patient under general anesthesia and consisted of implantation of the pulse generator and lead extensions and placement of the bur holes. Stage II was completed 1-7 days later, using only local anesthesia, and included stereotactic frame-based microelectrode recordings, semi-microstimulation and macrostimulation, and testing and placement of the stimulating electrodes. Stage I lasted approximately 90 minutes, whereas Stage II lasted approximately 230 minutes. All patients tolerated the procedures and received a complete implanted system. Deep brain stimulation therapy was typically initiated on the same day as lead implantation. When sequencing was reversed and bur holes were placed during the first stage while a patient was under general anesthesia, the patient was able to tolerate the second awake stage and was able to begin stimulation therapy within 48 hours of the second stage.
AB - Deep brain stimulation (DBS) is approved for several clinical indications; however, the sequencing of DBS surgery and the timeline for implementing stimulation therapy are not standardized. In over 140 cases so far, the authors have reversed the sequencing for staged implantation of DBS systems that was conducive to minimizing patient anxiety and discomfort while providing the opportunity to shorten the time between implantation and programming for therapeutic management of symptoms. Stage I was performed with the patient under general anesthesia and consisted of implantation of the pulse generator and lead extensions and placement of the bur holes. Stage II was completed 1-7 days later, using only local anesthesia, and included stereotactic frame-based microelectrode recordings, semi-microstimulation and macrostimulation, and testing and placement of the stimulating electrodes. Stage I lasted approximately 90 minutes, whereas Stage II lasted approximately 230 minutes. All patients tolerated the procedures and received a complete implanted system. Deep brain stimulation therapy was typically initiated on the same day as lead implantation. When sequencing was reversed and bur holes were placed during the first stage while a patient was under general anesthesia, the patient was able to tolerate the second awake stage and was able to begin stimulation therapy within 48 hours of the second stage.
KW - Anesthesia
KW - Deep brain stimulation
KW - Functional neurosurgery
KW - Neuronavigation
UR - http://www.scopus.com/inward/record.url?scp=84936760549&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84936760549&partnerID=8YFLogxK
U2 - 10.3171/2014.9.JNS14619
DO - 10.3171/2014.9.JNS14619
M3 - Article
C2 - 25748305
AN - SCOPUS:84936760549
SN - 0022-3085
VL - 122
SP - 1042
EP - 1047
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 5
ER -