Dr. Daniel R. Kramer, MD

DBS surgery may be completed in one operating session, but it is more commonly performed in two parts. In the first stage of the procedure, the surgeon will map targets in the brain using CT or MRI imaging to determine where to place the electrodes. Then, by drilling holes into the skull, the surgeon will place the electrodes into specific areas in the brain. The holes will be closed, and patients will require 1-2 days to recover in the hospital. After about two weeks, patients will undergo another surgery to have the deep brain stimulator implanted. The stimulator is usually placed under the skin around the collarbone, chest, or abdomen, and it will be connected to the DBS electrodes through a subcutaneous wire. No component of the DBS system will be visible from outside. Following stimulator implantation, patients may need to recover in the hospital for 1-2 days.

Within 2-4 weeks of the operation, doctors will program the stimulator using a wireless device. Patients will work with their doctor to determine the most effective settings for the stimulator during follow-up visits. Patients will be given a handheld device so that they can turn the stimulator on or off and adjust its settings themselves. The stimulator may have a rechargeable battery, in which case patients will be given a charging unit. Stimulator batteries generally need to be replaced in 3-5 years.

Hydrocephalus is most often treated with an implanted device called a shunt. A shunt is a long, thin tube that is used to drain excess fluid. One end is placed within the brain. The tube runs under the skin, along the neck behind the ear, and to another part of the body where the fluid can be reabsorbed. Most often this is the abdomen, but the chest or other areas can also be used. Shunts have a valve that allows doctors to monitor and control the pressure within the brain. Insertion of a shunt is a surgical procedure that takes one to two hours. Incisions are made in the head and the abdomen, and the shunt is threaded into place before the openings are stitched closed.

In cases where hydrocephalus is caused by a blockage, a procedure called endoscopic third ventriculostomy, or ETV, may be performed. During this procedure, a surgeon makes a dime-sized hole in the skull and uses a thin tube with a camera on the end (called an endoscope) to see inside the brain. The surgeon punctures a hole in the floor of the third ventricle, a fluid-filled space within the brain. The hole provides an opening for cerebrospinal fluid to flow around the blockage, normalizing pressure. The entire procedure usually takes less than an hour and patients can often go home the following day. ETV can provide a permanent and safe alternative to a shunt, but it is only useful for patients whose hydrocephalus is caused by a blockage.