Abstract
Correction: On 17th February 2016 the spelling of the second author's name was changed FROM Wasim Ali TO Wisam Ali. Abstract: Deep brain stimulation is the surgical treatment modality of choice for otherwise treatment resistant and affective disorders such as dystonia, tremor and Parkinson’s disease. Furthermore, DBS is now being used or investigated in the management of other conditions such as chronic pain, depression, obsessive compulsive disorder, Tourette syndrome, obesity, epilepsy and Alzheimer disease. The exact mechanism of action of DBS is not completely understood. The primary target sites vary according to patient’s symptoms. The various target sites are subthalamic nucleus, globus pallidus, pars internal and ventralis intermedius nucleus of thalamus. The surgical procedure involves insertion of electrodes into the target area of the brain through a burr hole. This is achieved through a combination of anatomical/imaging techniques (MRI and CT) and neurophysiological verification such as macro stimulation or micro-electrode recording. Once confirmed the electrode is connected via the cable to the pulse generator. The anaesthetic management describes the common and special consideration for awake DBS insertion and insertion under general anaesthesia and postoperative management of these patients. In our institute DBS has been practiced for well over a decade, allowing our multi-disciplinary team to build a large experience spanning both the main and experimental indications and across both the paediatric and adult age groups. The scope of this article is to understand the surgical steps and describe the practical aspect of conducting anaesthesia for patients undergoing
Highlights
Ablative procedures such as thalamotomy and pallidotomy were used to treat a range of neurological conditions such as Parkinson's disease (PD) and tremor
The option to deliver stimulation safely bilaterally along with the ability to titrate the stimulation to the needs of the patient and the reversibility of the technique, has made deep brain stimulation the surgical treatment modality of choice for many movement disorders such as dystonia, tremor and Parkinson disease
Patients should be informed of different locations of care- operating room (IV cannulation and placement of stereotactic frame on the skull) - MRI - back to operating room – Post-operative imaging to confirm the location of electrode and back to operating room for connection to the battery under general anaesthesia if the whole procedure is to take place on the same day
Summary
Ablative procedures such as thalamotomy and pallidotomy were used to treat a range of neurological conditions such as Parkinson's disease (PD) and tremor. The surgical procedure involves insertion of the electrode in to the target area of the brain through the burr hole, which is connected via the cable to the programmable pulse generator. The latter is usually placed just below the left clavicle (to avoid car seat belt pressing the battery) or in the abdomen. Once the electrode reaches the anatomical target, neuro-physiological evaluation is performed to accurately define the most clinically effective point within the target volume This may involve micro-electrode recording to look for signature activity of brain nuclei or macro stimulation in awake patients to observe improvement of symptoms and lack of any side effects. Anaesthetic consideration in awake DBS insertion Apart from the routine evaluation the specific considerations are: 1. Good psychological preparation
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