Deep Brain Stimulation (DBS) is a surgical treatment for movement disorders such as Parkinson’s disease, essential tremor, and dystonia. This therapy involves implanting thin wires, or electrodes, into specific, deep targets within the brain to deliver continuous electrical pulses. The overall surgical process is divided into multiple stages spanning days or weeks, but the core brain operation typically takes between four and eight hours. This duration accounts for the meticulous steps required to ensure the electrode is placed with millimeter-level accuracy.
The Core Surgical Timeline
The initial surgery to place the leads inside the brain is the most time-intensive part of the process, requiring a high degree of precision. The procedure begins with the attachment of a stereotactic frame to the patient’s head, which acts as a navigational guide for the neurosurgeon. This setup includes pre-operative imaging, such as a CT scan or MRI, which is merged with existing scans to create a three-dimensional map for trajectory planning. Once the trajectory is established, the surgeon makes a small incision and drills a burr hole into the skull.
The careful insertion of the electrode is the most time-consuming phase, sometimes guided by microelectrode recording to confirm the target location. The surgical team must confirm the electrode placement through testing before permanently securing the lead. After the lead is fixed and a coil of wire is secured under the scalp, the incision is closed, completing the main surgical stage.
Factors Influencing Procedure Length
The total duration of lead placement depends on the surgical approach. The traditional “awake” procedure often requires a longer operating time, typically ranging from five to seven hours, because it incorporates microelectrode recording and patient testing. During this method, the patient is briefly awakened so the surgeon can confirm optimal electrode placement by asking the patient to perform motor tasks.
In contrast, an “asleep” DBS procedure, which uses advanced intra-operative imaging like MRI guidance, can reduce the operating time, sometimes lasting closer to four hours. Since the patient is under general anesthesia, the surgical team relies solely on real-time brain imaging to guide and verify the electrode’s position. Bilateral implantation, which requires stimulation on both sides of the brain, will double the time necessary for the electrode placement phase.
The Second Stage of DBS Implantation
The second stage involves implanting the Internal Pulse Generator (IPG), the battery pack that powers the system, and is performed days or weeks following the brain surgery. This procedure is significantly shorter and less invasive, generally taking only one to two hours to complete. The IPG is typically placed under the skin in the chest area, just below the collarbone, similar to a cardiac pacemaker.
Under general anesthesia, the surgeon connects the previously implanted brain lead to an extension wire, which is then tunneled subcutaneously down the neck and shoulder to the IPG. Once the connections are made and the IPG is secured, the incision is closed.
Immediate Recovery and Hospital Stay Duration
Following the first stage of the procedure, patients are moved to a post-anesthesia care unit (PACU) for monitoring, which usually lasts one to two hours before transfer to a standard room. The typical hospital stay after the brain electrode implantation is brief, often lasting only one to three days for observation and monitoring.
For the second stage, the IPG implantation, recovery time is shorter due to the minimally invasive nature of the procedure. Patients frequently undergo this as an outpatient procedure, discharged home the same day, often within a few hours of completion. This shorter timeline allows the patient to focus on incision healing before the neurostimulator is activated and programmed several weeks later.