Deep brain stimulation surgery (for Parkinson disease)
Paragraph #1 : Naming the steps/ Prep part 1
Step1. Evaluate the patient.
Step2. Put in the fiducials.
Step3. Preform the brain surgery.
Step4. Put in the battery packs. Step5. Activate and set the system.
Fiducials (screws) are put in to act as markers for the surgery; they must be put firmly into the skull so the skin doesn’t move to get precise measurements. Typically set several days before surgery, six fiducials will be needed for this procedure, 2 in forehead, 2 above each ear, and two in back of head.
Fiducials are placed there because they need to be out of the way of the trajectory for the stimulation probe.
First you will numb the areas so the patient won’t feel it, use the scalpel and make small incisions where the fiducials will go, blot away blood, then use a screw driver to put the fiducial into the skull.
Now the patient will be sedated and will undergo a CT and MRI scan, these two scans will be used to create a very detailed three dimensional picture of the skull and brain. They use a GPS to help plan a surgical trajectory in advance, the computer will combine the images and help them locate the Subthalamic Nucleus, There they go over many trajectories until they find the one that will avoid the possibility of brain damage and save it in the computer for the day of surgery.
Paragraph#2: Prep part 2/ Surgery
On the day of surgery the doctors go over the papers once more to see that she is approved an able to handle the surgery. The nurses already have her in the operating chair in a monitored anesthetic condition, relaxed an sleepy but able to be quickly brought back to relative normalcy. they start by shaving her hair, already have chosen the trajectory on the GPS they need to mark it on the patients head. They do this by using non scale probes by the position of the fiducials with the GPS system, and that information will tell where to put the incision marks. left controls right, right controls left. after making the marks with have to scrub the patients head multiple times with betadine solution. then they inject the patient around the head and where the incision will be with a local anesthetic to make sure the patient stays comfortable during the surgery. they will clean the head two more times using Duraprep solution making sure to scrub the fiducials. they change their gloves and put on sterile surgical gloves they need to put sterile towels around the patients scalp to protect the patient from infection and hold the towel in place using IOban a batadine infused sticky plastic. next they’ll put a layer of IOban around the whole scalp, another large plastic drape is put over the scalp and shoulders. And they’re ready for the surgery. they take the scalpel and make a incision where they marked earlier, then use the bovine to stop the bleeding around the incision. They pry open the incision and take the drill to make two holes exposing the brain. While someone does that another person uses saline solution during the drilling to wash bits of bone out of the surgical incision, and to cool the drill hole. They will use a tower system to guide the placement of the recording electrode and ultimately the stimulational
