Dr. Kunal Gupta, MD, PhD, FAANS

To perform a craniotomy, the surgeon will need to make an incision on the scalp to expose the skull. Some of the hair may be shaved, and the scalp will be cleaned with antiseptic solution. Following the incision, the surgeon will use a drill to remove a piece of the skull, called a bone or skull flap. If the surgeon needs to reach a tumor or perform an aspiration, the dura, which covers the brain, will be incised (cut) to access the lesion. The bone flap will be reattached once the surgeon has completed the procedure. If the surgeon is performing a craniectomy, the same steps will be followed, but a mesh piece will be placed where the bone flap was, and the scalp will be surgically closed. Patients will need to wear a special helmet for a few months after the procedure. The bone flap will be preserved and replaced during a later operation, or it may never be replaced.

Patient recovery period can range from two days to two weeks, depending on the specific procedure and condition. Patient will require monitoring and may be given medication for pain or brain swelling. Patients will have to restrict their physical activity for some time after the procedure, and they may need to work with a physical therapist.

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.