Asleep DBS in Florida
Deep brain stimulation (DBS) was first used by neurologic surgeons in the United States in 1997 at Mayo Clinic in Jacksonville, Florida. Since then, thousands of people with Parkinson's disease, dystonia, essential tremor and other conditions have been successfully treated with DBS.
Traditionally, patients are awake during the procedure, allowing them to respond to directives from surgical teams and help ensure correct placement of electrodes in the brain.
Patients at Mayo Clinic's campus in Florida now have the option of treatment with DBS under general anesthesia. Asleep DBS uses intraoperative MRI to guide electrode placement, eliminating the need for microelectrode testing during surgery. As a result, asleep DBS is generally a shorter procedure than awake DBS — lasting only about three hours — and patients with Parkinson's disease aren't required to stop taking medications beforehand. The procedure is particularly suitable for patients with dystonia or Parkinson's disease that isn't tremor-predominant.
"There is no question that patients would prefer to be asleep during DBS, and the results of surgery are at least equal to the awake procedure," says Robert E. Wharen Jr., M.D., chair of Neurologic Surgery at Mayo Clinic in Jacksonville, Florida.
Intraoperative MRI guidance
Asleep DBS is performed in Mayo Clinic's intraoperative MRI operating room. The patient is given general anesthesia and the head is secured to the operating table; a stereotactic frame isn't necessary. An alignment grid is placed on the patient's head and MRI is performed to pinpoint the target and trajectory for electrode placement. A small incision is made through the skull and a special alignment tower attached to the scalp. "All of this can be done through a 2-centimeter incision," Dr. Wharen says.
MRI is repeated to ensure precise placement of the alignment apparatus. Electrodes are then placed down the trajectory, and MRI is used to verify alignment. Once the electrical lead is secured, the procedure is completed as awake DBS is, with implantation of the pulse generator in the chest.
"Asleep DBS eliminates the time and risk of hemorrhage from microelectrode recording," Dr. Wharen says. "Trauma to the brain is minimized because you only ever make one pass. The intraoperative MRI means you're watching throughout the procedure and confirms that you're exactly where you want to be."
Mayo Clinic brings to this new procedure its investment in intraoperative high-resolution MRI and the clinic's highly experienced surgical team. "Our patients who have asleep DBS don't experience the confusion and longer hospitalization we can see with patients after awake DBS," Dr. Wharen notes. "While the long-term results for our patients with asleep DBS are at least as good as for those who have awake DBS, the short-term results are even better."