This video recording was taken in the operation theatre at University Malaya Medical Centre, Kuala Lumpur in November 2004. The DBS surgery was performed by neurosurgeons, namely Professor Tipu Aziz (the world expert on Parkinson’s brain surgery) and Professor Vickneswaran, with the assistance of Dr Chew Nee Kong (neurologist).
There are two parts of the DBS surgery:
|Step 1||Step 2|
|MRI brain scan helps the surgeon in locatingthe target area in the brain wherethe needles(electrodes) should be placed. The targetarea in the brain is usuallysubthalamicnucleus (STN).||Stereotactic frame is placed on the head toguide the insertion of needles (electrodes) to theprecise location of the target area.|
|Step 3||Step 4|
|Assessment before needles (electrodes)are inserted – tremor and slowness of movementare obvious. The initial documentation of symptomsis important because it helps the doctors to assessthe degree of improvement of symptoms after theneedles (electrodes) have been inserted. Anysignificant improvement (usually within minutes)indicates that the needles (electrodes) are at theright location, and thus the surgery has been
|The scalp is washed with “shampoo” (disinfectant).|
|A hole is manually drilled in the skull, through which the needles (electrodes) are inserted. Prior to this, the scalp has been adequately injected with painkillers (local anesthetics).|
|The needle (electrode) is inserted into the brain. Video 6-b shows a close-up view of the needle (electrode), as it is placed next to a ruler|
|Step 7||Step 8|
|After needle (electrode) has been inserted, the tremor almost immediately disappeared while hand movement is faster. These are the indications that the surgery has been successful. Remember that the patient is fully awake during this stage of DBS surgery.||The position of the needle (electrode) on the scalp is secured with stitch.|
|Step 9||Step 10|
|The patient’s scalp is cleaned up.||Still in the operation theatre. The patient’s hand movement has clearly improved while the tremor has disappeared.|
|Step 11||Step 12|
|The DBS surgery team members are jubilant.Patient waves his hand as a signal of victory.||Patient has been transferred from the operation theatre to the recovery room. He is happy with the dramatic improvement in movement and tremor.|
|Step 13||Step 14|
|Two hours after surgery – examined by neurologist.No more stiffness tremor and slowness of moment.
|Two hours after surgery. Walks with normal speed. Note the presence of dyskinesia (i.e. swinging movement of both hands) due to electrical stimulation of the brain cells. The development of dyskinesia right after brain surgery indicates that the surgery is successful.|
This was performed the following day, under general anesthesia (patient is put to sleep by inhaling gas). Video 15-a shows the incision (cut) which is made in the chest wall, with the battery already embedded under the chest wall muscles. Video 15-b is a close-up view of the battery. After the incision has been stitched up (Video 15-c), all there is left to be seen on the exterior is a bulge on the chest wall.
|15 – a|
|15 – b|
|15 – c|