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During the surgery
Because the procedure is experimental for depression, it may not be performed the same way everywhere. In general, here's how surgery for deep brain stimulation works.
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Brain surgery. For the brain surgery portion, you're given local anesthetic to numb the surgery area. You won't need anesthetic in your brain itself, because the brain has no pain receptors. You'll remain awake and alert during the procedure so that the surgeon can talk to you to make sure the proper areas of your brain are being stimulated.
Your head is placed in a brace to keep it still during surgery. Two small holes are drilled in your skull. Guided by imaging techniques, the surgeon implants electrodes on both sides of your brain. You may undergo testing during the surgery to see how your mood is affected by the stimulation.
- Chest surgery. During the second portion of the surgery, the surgeon implants the pulse generator in your chest, near your collarbone. You're put to sleep with general anesthesia for this surgery. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated pulse generator.
After the procedure
After surgery, you'll need to take antibiotics to lower the risk of infection. A week or so after surgery, the pulse generator in your chest is activated in your doctor's office. The amount of stimulation is customized to your situation, based on your mood and side effects.
Stimulation is generally constant, 24 hours a day. The pulse generator can be easily programmed from outside your body with a hand-held magnetic device you're given to use. With this, you can temporarily turn off stimulation by holding the magnet over the area of your chest where the pulse generator is implanted. When you move the magnet away, stimulation restarts.
You must remain in close contact with your surgeon or other specialist involved, to make sure that the pulse generator is working correctly. You may also need to continue standard depression treatments, such as taking antidepressants.
- Read CN, et al. Psychiatric neurosurgery 2009: Review and perspective. Seminars in Neurology. 2009;29:256.
- Larson PS. Deep brain stimulation for psychiatric disorders. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics.
- Deep brain stimulation. NeuroSurgeryToday.org. http://www.neurosurgerytoday.org/what/patient_e/deep%20brain%20stimulation.asp. Accessed June 15, 2010.
- Howland RH. Neurosurgical approaches to therapeutic brain stimulation for treatment-resistant depression. Journal of Psychosocial Nursing. 2008;46:15.
- Rabins P, et al. Scientific and ethical issues related to deep brain stimulation for disorders of mood, behavior, and thought. Archives of General Psychiatry. 2009;66:931.
- Tye SJ. Disrupting disordered neurocircuitry: Treating refractory psychiatric illness with neuromodulation. Mayo Clinic Proceedings. 2009;84:522.
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