Deep Brain Stimulation Now More Comfortable for Patients

Technology that eases tremors now less restrictive
Photos of equipment in O.R. and Dr.Lobel

A new frameless platform makes deep brain stimulation treatment for Parkinson’s disease and other conditions much more comfortable for patients.

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Surgeons use deep brain stimulation (DBS) to treat symptoms — usually tremors — that can’t be well-controlled with medication. It has been very helpful in controlling symptoms, but the patient has always had to endure being bolted into a heavy frame. The frame clamps the head, immobile, to the operating table for hours.

But not anymore, says neurosurgeon Darlene Lobel, MD. The new frameless DBS uses a lightweight, less-restrictive platform that gives patients a bit more freedom to move. Meanwhile, it lets surgeons complete the operation with the same level of accuracy, as the platforms aid the surgeon in precision targeting during the procedure.

“Over the past several years, a few companies have started making frameless systems. They’re customized platforms that are very lightweight and individualized to the patient,” Dr. Lobel says. “Tiny screws are still needed in the skull, but there’s no need for the big metal frame attachment.”

Precision fitting before day of surgery

The platform weighs only a few ounces. It is constructed using the patient’s CT and MRI scan that identify the exact spots in the brain that need surgical intervention.

On the same day the patient is fitted for the platform, the surgeon makes tiny, nearly painless incisions to place the 2-mm screws that secure the platform to the head during surgery.

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The lighter-weight platform is the only difference between the traditional and frameless DBS procedures. Traditional DBS uses a metal frame bolted to the operating table, forcing patients to lie still. Otherwise, framed and frameless DBS procedures are the same.

With the platform in place, surgeons make a small, quarter-sized opening in the skull and slide thin, metal electrodes directly into the areas of the brain that they are treating.

DBS works much like a pacemaker. It sends electrical impulses into the brain to help lessen tremor, rigidity and stiffness that plague Parkinson’s or essential tremor sufferers.

Less restrictive option works for most patients

The lighter-weight platform is a particular relief to patients who are uncomfortable with or scared of being strapped down by their head during surgery, Dr. Lobel says.

“This is a very good choice for any patient who is claustrophobic,” she says. “Seeing a big metal frame around your head isn’t ideal for those patients.”

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Using the platform also makes surgery time shorter. Patients no longer have to spend an entire day at the hospital. With the screw placement and CT scan already done, patients only have to show up for the three- to six-hour procedure to place the implants.

And the frameless procedure works for nearly any patient who needs DBS to control his or her symptoms, Dr. Lobel says. 

“Frameless DBS is an excellent option for patient comfort,” she says. “The accuracy is within 1 mm of the locations we identify for treatment, and the outcomes after the surgery with the frameless method are identical to the frame-based procedures.”

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