New Approach Will Simplify Parkinson's Surgery

Madison, Wisconsin - A UW Hospital and Clinics neurosurgeon has performed the first-ever deep-brain stimulation (DBS) procedure in the hospital's new intra-operative MRI (iMRI) suite.

The suite allows neurosurgeons to perform faster and more accurate brain surgery while a real-time magnetic resonance image of the patient's brain is displayed. UW is the second academic medical center in the nation to have such a system. For patients, the result is a faster and more comfortable experience with reduced surgery time and the use of anesthesia.

"This makes DBS surgery much easier on our patients,'' says Dr. Karl Sillay, a UW Health neurosurgeon. "Previously, patients had to be awake during the surgery to help determine when the electrodes were in the correct position."

Deep brain stimulation (DBS) improves the symptoms of Parkinson's by directing electrical stimulation to the subthalamic nucleus. In the past, surgeons located the spot by scanning the patient before surgery. A stereotactic frame, affixed to the patient's skull, allowed surgeons to identify the spot by use of three-dimensional coordinates. Micro-electrode recordings were used to ensure the electrode was in the correct place. Patients were awake and responded to the surgeon for this technique to work correctly. They also stopped taking their anti-Parkinson's medication 12 hours before surgery.

In the new iMRI suite, surgeons use the image from the iMRI to guide the electrode into place. A computer system created by Surgivision uses a plastic grid on the patient's head, coordinated with the iMRI image, to precisely guide the neurosurgeon's placement of the electrode. Special surgical tools, made of titanium and plastic, allow surgery inside the powerful MRI magnet.

Patients can stay on their medication and be under general anesthesia. The new technique also has a safety component: since intracranial bleeding occurs in about 2 percent of DBS procedures, surgeons can spot the problem immediately on the real-time iMRI.

The technique will get much of its use during procedures when electrodes are placed in the brain to relieve the symptoms of Parkinson's disease, essential tremor and other neurological conditions. But the iMRI operating room is also being used for other types of brain surgery.

For example, says Robert Dempsey, MD, chair of neurosurgery, having the MRI right in the operating room will also benefit brain tumor patients.

"This superb technology provides our surgeons with additional images of the tumor while the patient is undergoing surgery," Dr. Dempsey says. "This means we are able to operate with additional certainty that the entire tumor has been removed during a single surgery, and helps ensure we are doing our very best for patients in sparing healthy tissue."

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