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In This Video

  • Deep brain stimulation (DBS) technology has rapdily evolved over the past few years
  • Brain MRI scanners can position DBS electrodes appropriately by using direct targeting within the scanner
  • With new technologies, patients can be asleep if they're anxious about surgery. For those who have severe tremor or dystonia, they don't have to worry about discomfort during surgery

Mark Richardson, MD, PhD, director of the Functional Neurosurgery Program in the Department of Neurosurgery at Massachusetts General Hospital, discusses the evolution and successful use of deep brain stimulation to treat those with movement disorders. In this video, Dr. Richardson explains how the use of new technologies, such as brain imaging, are used to enhance surgical outcomes.

Transcript

Deep brain stimulation is a field that has evolved fairly rapidly in the past few years because of new device technology. For patients with movement disorders, a very common question is when to reverse into it for deep brain stimulation and the answer to this is more simple than people think. It has to do with the person's quality of life. For most people with Parkinson's disease, essential tremor dystonia will reach a point where medical management is not providing the same benefits that it did previously. And it's at this stage when patients can no longer do the things they want to do that really make them who they are that they should consider deeper simulation, which has very low morbidity and in many cases very high chance for success.

Robotics are playing an increasing role in surgery in general, and in functional neurosurgery, we use robotic stereotactic assistance in order to implant things in the brain. The reason for that is to streamline the process and make it safer and more accurate for patients so we can really achieve a very high degree of precision.

Traditionally implantation of DBS electrodes has been done with the patient awake so that the target nucleus can be mapped with electrophysiology in order to determine the right place for the DBS electrode. But with a new technology that's been developed over the past several years, we can now position the electrode appropriately without electrophysiological confirmation by using direct targeting in an MRI scanner. And we have vast experience working with this technology. We use a Clearpoint device to obviously convert the MRI to the operating room. This has several advantages for patients. They can be completely asleep, so if they're anxious about surgery, this is no longer an issue. For patients who have severe tremor or dystonia, they don't have to worry about discomfort during surgery, and the method is highly precise.

There is some debate about whether asleep or awake DBS is better. It is our philosophy that this is not really debatable and we published some of our own results showing that these two methods are equivalent and the great thing for patients is that they can now choose which approach they think is better for them and both have equal chances of success.

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