Our Summary
In a study of patients undergoing deep brain stimulation (DBS) surgery for movement disorders, researchers found that the position of the implanted brain leads (wires) can shift between the day after surgery and one month later. This change in position can affect the area of the brain that is stimulated by the electric field (EF) produced by the leads.
The research involved 23 patients who had DBS surgery. Using computed tomography scans, the researchers tracked the position of the leads at two points in time: the day after surgery and about one month later. They found significant displacement, or movement, in the position of the leads. This was more pronounced on the left lead, which tended to move laterally, towards the front, and downwards. On the right lead, there was a tendency for it to move towards the front and downwards.
The method used to secure the leads, or the anchoring technique, was found to be a significant factor associated with this displacement. However, other factors such as whether the patient had a single or double DBS, their gender, age, or the calculated air volume in the brain did not show a correlation with lead displacement.
The researchers also simulated the EF produced by the active contacts on the leads to understand the impact of lead displacement on the area being stimulated. They found that the volume of brain tissue being stimulated was reduced after one month due to changes in the space around the electrode and due to the displacement of the leads.
The findings suggest that movements of the leads and changes in the space around the electrode are reasons for delaying programming of the DBS device to four weeks after surgery.
FAQs
- How does the position of the implanted leads change after deep brain stimulation surgery?
- What factors are associated with the displacement of the leads after DBS surgery?
- How does the displacement of the leads affect the area of the brain being stimulated?
Doctor’s Tip
Therefore, it is important for patients to follow up with their doctor regularly after brain surgery to monitor the position of the leads and ensure that the area of the brain being stimulated is optimal for their treatment. It is also important for patients to report any changes in symptoms or side effects to their doctor, as this could be a sign of lead displacement. Regular monitoring and communication with your healthcare team are key to successful outcomes after brain surgery.
Suitable For
Patients who are typically recommended for brain surgery include those with movement disorders such as Parkinson’s disease, essential tremor, or dystonia, as well as patients with epilepsy, brain tumors, traumatic brain injury, or certain psychiatric disorders such as obsessive-compulsive disorder. Patients who have not responded well to medications or other treatments may be considered for brain surgery as a last resort.
Timeline
Before brain surgery, a patient typically undergoes a thorough evaluation process to determine the need for surgery and the specific procedure to be performed. This may involve consultations with neurosurgeons, neurologists, and other specialists, as well as various imaging tests such as MRI or CT scans.
On the day of surgery, the patient will be admitted to the hospital and prepared for the procedure. The surgery itself may last several hours, during which the neurosurgeon will carefully access the brain and perform the necessary interventions.
After brain surgery, the patient will typically spend some time in the hospital for monitoring and recovery. This may involve staying in the intensive care unit (ICU) for a period of time, depending on the complexity of the surgery and the patient’s condition.
Once discharged from the hospital, the patient will continue to recover at home. This may involve follow-up appointments with the neurosurgeon or other healthcare providers, as well as physical therapy or other rehabilitation services to help with recovery and regain function.
In the weeks and months following surgery, the patient will continue to be monitored for any potential complications or side effects, and adjustments may be made to their treatment plan as needed. It is important for patients to follow their healthcare provider’s recommendations for post-operative care and to report any new or worsening symptoms promptly.
What to Ask Your Doctor
- How will you secure the leads during surgery to prevent displacement?
- What measures will be taken to monitor the position of the leads post-surgery?
- How will lead displacement impact the effectiveness of the deep brain stimulation therapy?
- Are there any potential risks or complications associated with lead displacement?
- How frequently will the positioning of the leads be checked after surgery?
- What symptoms should I watch for that may indicate lead displacement?
- Will the displacement of the leads require any additional procedures or adjustments to the DBS device?
- How long should I wait before starting the programming of the DBS device after surgery to allow for any potential lead displacement to stabilize?
- Are there any lifestyle modifications or precautions I should take to minimize the risk of lead displacement?
- How often will follow-up appointments be scheduled to monitor the positioning of the leads and assess the effectiveness of the therapy?
Reference
Authors: Göransson N, Johansson JD, Wårdell K, Zsigmond P. Journal: Stereotact Funct Neurosurg. 2021;99(3):221-229. doi: 10.1159/000511406. Epub 2020 Dec 16. PMID: 33326986