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Waywrd1

Non-invasive DBS Frame?

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Is anyone testing/working on upgrading the frames used in DBS? Personal opinion, they're incredible but pretty medieval at this point.

 

Edited by Dr. Okun

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Yes, there are several groups who have introduced alternative targeting approached and even frameless approaches.

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There are several small studies published using frameless technology.  Results are similar, but studies are small and a lot has to do with the experience of the surgeon.  A frameless approach requires implanting several small plates below the scalp before the operation (to screw the system into).  So it is a little more involved....

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I had frameless DBS surgery done.  Currently a four to six month waiting time on the good Doctor's schedule as he does one DBS surgery a week, but often trains other surgeons on the technique. 

 

There is an advantage of not having the large frame, and being able to have some movement possible. The down side is fiducials are done a day before.

 

Two weeks prior, had a two hour 3T MRI.  Full sedated, but a very details brain image. Day before surgery was Fiducial Placement and a very quick CT Scan.   The neurosurgeon then overlaps those images with a real time graphics. 

 

You are to remain awake during all the surgery, and the Anesthesiologist may use a light "twilight" on the person to help them relax.  It was a bit of a panic mode as I suddenly had ZERO tremors! No body rigidity, and no tremor during the  procedure.  This occurred before the sensing probes were inserted. The Medtronic Engineer seemed a bit frustrated/upset but my Neurosurgeon was cool and calm and had me start stretching my hand out and open/close rapidly as probe was inserted and removed. GPi placement was done as I have both Parkinson's and Dystonia, MDS felt for me GPi made the most sense.

 

Oddest thing in the morning after DBS Lead placement. No stiffness, none at all. Took my usual sinement/comtain cocktail and was nausea.  First time I have ever had that reaction.  

 

As to anyone thinking frame vs frame less, more important quest is what is the neurosurgeon most comfortable with? If they have 100's of DBS surgery's using one method, I'd rather go with what they are used to!

 

Photo's of fiducial placement:  The metal "pegs" are drilled into place.  Little power drill, final installation with a screw driver.

 

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 I may not get it, but I don't see the advantage in this frameless method. Does it lead to more accuracy? While the injections for the conventional head gear are very uncomfortable (they hurt like hell), the process is over in a few minutes. 

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Very small studies show comparable results frame versus frameless in the hands of EXPERIENCED neurosurgeons.  I think the post was completely correct when it referred to the idea of experience.  The frameless requires implanting fiducials on the head a day or so before the operation.

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Why are the fudicals and or frame screws so far down on forehead- Does the steep frontal angle access that areas of the brain with less potential damage?

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Great questions.  I am actually not sure of the engineering and location of the screws but suspect it is strategic and placed there for safety and accuracy but I must admit not my area of expertise.

 

The angles chosen by the surgeon should be the safest approach that allows the lead to be placed in position to maximize benefits and minimize side effects.

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