What to Expect

How to prepare

Pre-admission assessment

You have your pre-admission clinic​ appointment a few days or weeks before your surgery. This visit takes about 3 to 4 hours in order to obtain blood work, an ECG, an x-ray and have a consultation with an anesthetist. The pre-admit nurse will review instructions on how to prepare for the surgery.

Please bring the following with you:

  • Your Ontario Health Card.
  • All medications you take and their containers.

If there are any changes in the booking of your surgery, you will be called by the pre-admission department.

If you cannot go to your surgery, call the doctor's office as soon as you know. If you are unable to reach the doctor, then leave a message at the surgeon's office.

Part of planning for your surgery is making arrangements for someone to:

  • Drive you home from the hospital after surgery.
  • Stay in your home to care for you the first week after surgery.

Day before your surgery

  • Do not eat any food or drink after midnight the night before your surgery. Your stomach must be empty.
  • Take a shower the night before or the morning of your surgery.
  • Please bring with you a list of your current medications. This includes prescription medications, over-the-counter medications, vitamin or mineral supplements and herbal remedies. The nurse will go over these medications and instruct you on them for the surgery.

Day of surgery

  • Do not take any Parkinson's or tremor medications.

Checking in

When you arrive at the Pre-Operative Care Unit (POCU) in the Fell Pavilion (2nd floor) at 6:00 am, check in at the reception desk. Please have the following ready:

  • Health card (OHIP card).
  • Your name, address and date of birth.
  • All the medications you regularly take in their original containers.
  • You may also want to bring personal items, such as photos or reading materials

Before the Deep Brain Stimulation

After check in, the nurse will admit you and help you get ready for surgery. They will check your blood pressure, pulse, temperature and breathing. They will also put an intravenous (IV) in your arm and help you change into a hospital gown.

We put a special frame on your head. This frame has 2 pins at the front and 2 at the back to keep your head still during surgery. We give you a medication (local anesthetic) with a small needle to numb the areas where the pins are put in.

You will have pictures taken of your brain. You will have a brain MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scan. These tests create detailed images of your brain that help your neurosurgeon position the DBS electrodes. Please try to stay as still as possible. This helps the technician get the clearest pictures of your brain.

  • If you have an MRI, a box and coil are attached to the frame. This may feel heavy. After the MRI, we remove the box and coil. Only the frame will remain on for the surgery. The MRI takes about 45 minutes.
  • If you have a CT scan, it will take 15 minutes.

After the tests, you will go to the holding area. A nurse will check that everything is ready for your surgery. You will see the anesthetist, who will give your anesthetic and monitor your during your surgery.

During the Deep Brain Stimulation

When everything is ready, you go to the operating room. The surgical team helps you move onto the operating table and get comfortable. The table is angled so your back is raised, but not all the way. Your head frame is attached to the table to keep your head still.

Step 1: Placing the Electrodes

You may be given a sedative to make you relaxed but awake enough to answer questions about how and what you feel when the electrodes are stimulated. Your answers help the neurosurgeon confirm the right placement of the electrodes.

The neurosurgeon will:

  • Shave and wash your head with a special soap that kills germs.
  • Numb parts of your scalp so you will not feel pain.
  • Make an incision (cut) on the top of your head and a small round opening in your skull (about the size of a nickel). If you are having surgery for both sides of your body, you will have two openings in your skull.
  • Put in each electrode so the tip is in the proper area of your brain.
  • Stimulate the electrodes and measure how your brain cells react.
  • Ask you what or how you feel and whether you feel things like tingling or numbness.
  • Check your stiffness, tremor and movement to make sure the proper areas of your brain are stimulated.
  • Use plastic caps to close the holes and make sure the electrodes stay in place, and close the incision with staples.
  • Remove the frame from your head.

Step 2: Placing the Extension Wires and IPG

The anesthetist will give you medication (general anesthetic) so you will be asleep during this part of the surgery.

The surgeon will:

  • Connect the extension wires to the electrodes.
  • Place the extension wires under your skin, from the top of your head, behind your ear, down your neck to your chest.
  • Connect the extension wire to the IPG unit.
  • Place the IPG under the skin below your collarbone. It will remain off.
  • Close the incision in your chest with staples.

How long will surgery be?

Step 1 takes 4 to 6 hours, depending on the number of electrodes needed and complexity of the surgery. Some patients have step 1 and 2 done together. Others have Step 1 and 2 done separately, two or three days apart. If you are having Step 2 later, the end of your electrodes will be left outside of your head and covered by a bandage. Step 2 takes about 45 minutes.

After surgery

When the surgery is finished, you will go to the Post Anesthetic Care Unit (PACU) for 1 to 3 hours to recover.

  • The nurses in PACU check your blood pressure, pulse, temperature and breathing often, as you wake up. If you have pain or nausea, they will give you medication that will help.
  • You may have an oxygen mask over your mouth and/or nose.
  • There will be a bandage covering the incision on your head and chest.

When you are ready, you will go to your room on the Neurosurgery Unit 5A or 5B​.

  • In the Neurosurgery Unit, your health care team continues to check your condition and progress.
  • You may have a headache, feel pain at your incisions or feel sick (nausea).
  • This will gradually get better. The nurses can give you medication to help, if needed.
  • In the afternoon or evening, you can start to drink and eat.
  • Later in the day or the next day, the nurses will help you get out of bed and walk. You may feel dizzy, so it is important that someone is with you the first few times you get out of bed.
  • You will have another MRI or CT scan to check the position of the electrodes.

The day after your surgery, we may invite you to take part in research studies to help us learn more about how the brain works. You can decide whether or not you wish to take part. Your decision will not affect your care in any way.

Discharge home

Discharge home

You can expect to go home 1 or 2 days after the IPG is placed in your chest.

Before you leave the hospital, we will:

  • ​Teach you how to take care of yourself and your incisions
  • Tell you when your DBS system will be turned on
  • Tell you about your follow-up appointments

On the day you go home, please arrange to be picked up before 11:00 am. ​​

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