May 1, 2006 In a method called deep brain stimulation, certain movement disorders are treated by implanting wires in the brain that deliver electrical signals. The surgical procedure can last up to eight hours, during which patients are kept awake and have to stay completely still, hooked to a bulky device. A new, lighter device now cuts down operating time by up to two hours and allows patients some mobility during surgery.
RICHMOND, Va.--For patients with some types of movement disorders, a deep brain stimulation procedure can be a godsend. Until now, surgeons had to use a big, bulky device to hold patients still. But a new invention is making the surgery much easier on doctors and patients.
Three months ago, Tiffany Knight could barely walk down a hallway. A movement disorder called dystonia confined her to a wheelchair for most of her teen years.
"It was frustrating and crippling. It was just hell," she says. "I was really, really depressed about it. I was embarrassed. I wasn't able to drive and go places."
But today, Knight has a life. She walks so fast, her grandmother can barely keep up! A procedure called deep brain stimulation, or DBS, is what helped her.
Until now, doctors used a bulky device to hold patients in place during deep brain stimulation surgery, which usually lasts about eight hours and requires patients to stay awake!
"You're essentially bolted to the table, so you can't move, and for many patients, that's the most frightening aspect of the surgery," Neurosurgeon Kathryn Holloway, of the VCU Medical Center in Richmond, Va., tells DBIS.
Now, Dr. Holloway uses a small, frameless device called NexFrame that's attached to the head with tiny screws. It's just as accurate, but patients can move, and operating time is reduced by about two hours.
"It makes it a lot more comfortable. Plus, we could see the patient much better," Dr. Holloway says. She used the new device on Knight, and it was a success.
Now, Knight's looking forward to starting her new life. "I feel like I actually have a future now. Before I didn't," she says. "I thought I was going to have to be dependent on people the rest of my life." Now, she can be as independent as she wants.
Deep brain stimulation can also be used on patients with Parkinson's, essential tremor, Tourette's and OCD. Right now, there are about 40 surgeons in the country using the new frameless device.
BACKGROUND: The "frameless" NeXframe device is a small, lightweight plastic tower that attaches to a patient's head during surgery to support surgical instruments, thereby improving patient comfort and reducing surgical time. It is now being used by physicians in 20 hospitals around the world to perform delicate surgical procedures deep inside the brain.
HOW IT WORKS: About the size and weight of a plastic coffee cup, the new equipment is meant to replace to very bulky metal frame normally bolted to a patient's head and then to the operating table. The frameless device is especially useful in deep brain stimulation procedures, which require a great deal of precision because they involve placing tiny electrodes into remote areas of the brain to treat such problems as Parkinson's disease, tremors, and dystonia (involuntary twisting body movements or postures). Frameless devices are increasingly being used in neurosurgery, but surgeons had been reluctant until now to abandon the old method of large metal frames because stimulating the deep parts of the brain require that surgeons touch points accurately. The frameless configuration allows patients to shift positions during the operation, which can last 6 to 8 hours, although it can also reduce surgical time to about two hours, because the MRI and CAT scan images of the brain can be made days in advance, rather than once the large bolted frame is in place.
ABOUT DEEP BRAIN STIMULATION: Deep brain stimulation is an interactive procedure that requires surgeons to pinpoint precise areas inside the brain that are misfiring. Tiny electrodes are implanted into the brain and then connected to a pacemaker that can be programmed to "turn off" the areas that are causing tremors or difficulty walking. During surgery, patients are asked to make eye contact with doctors and to perform various movements so surgeons can identify those areas of the brain in need of treatment.
ABOUT CAT SCANS: CAT (Computerized Axial Tomography) scans are similar to conventional X-ray imaging, but instead of imaging the outline of bones and organs, a CAT scan machine forms a full three-dimensional computer model of the inside of a patient's body. Doctors can even examine the body one narrow slice at a time. The X-ray beam moves all around the patient, scanning from hundreds of different angles, and the computer takes all that information to compile a 3D image of the body.
Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.