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San Francisco VA Health Care System

 

SFVAMC 1st VA in Nation to Perform MRI DBS Surgery

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SFVAMC’s Chief of Neurosurgery Paul Larson, MD

“For many years, if you were a Parkinson’s patient and you wanted to have DBS, there was only one option, the ‘awake’ surgery," says SFVAMC’s Chief of Neurosurgery Paul Larson, MD. “Now patients have a choice: They can have the longer, traditional procedure, or they can have the ‘asleep’ MRI technique. At the end of the day these are both reasonable ways to implant electrodes.

By Kellie Burdette Mendonca, Public Affairs Specialist
Monday, November 18, 2013

The San Francisco VA Medical Center (SFVAMC) has become the first VA Medical Center in the nation to perform MRI-guided deep brain stimulation (DBS) surgery. The surgery was successfully performed by SFVAMC’s Chief of Neurosurgery Paul Larson, MD, on a Veteran patient with Parkinson’s disease.

DBS surgery is a two-step process involving the placing of an electrode into the brain, and then implanting a battery pack under the patient’s skin near the chest. DBS is typically performed for eligible patients whose Parkinson’s medications no longer work well. The surgery helps to relieve or reduce symptoms of the disease such as tremors.
 
Traditionally, DBS surgery has been performed with the use of a technique called “brain mapping” with the patient awake while the neurosurgeon implants an electrode into the brain, relying on behavioral cues from the patient for accurate placement. The two-step, “awake” DBS surgery is lengthy and is apt to cause more discomfort for patients as they must go off their Parkinson’s medications prior to surgery, their Parkinson’s symptoms are active during the surgery, and recovery takes longer, according to Larson.

With the newer “asleep” method--developed 10 years ago by Larson, fellow neurosurgeon Phillip Starr, MD, and imaging scientist  Alastair Martin, PhD, at SFVAMC’s partnering  university, the University of California at San Francisco--the entire surgery is performed inside an MRI scanner using non-magnetic, titanium instruments. Patients don’t require brain mapping because surgeons use MRI technology to see inside their patient’s brain for pinpoint accuracy in placing the electrode. The “asleep” procedure takes half the time of an “awake” procedure, patients stay on their Parkinson’s medication during surgery, and they recover more quickly.  After an overnight stay, patients return in a week or two to have their battery pack installed, a simple 30-minute outpatient procedure done in a regular operating room.

“This MRI-guided technique can also be applied to other procedures as well,” says Larson. “You can use this system to do brain biopsies for brain tumors, for drug infusions for new therapies like chemotherapy for brain tumors, and for gene therapy for Parkinson’s disease. We’ll start using the MRI-guided system and technique for these types of applications as the program grows here at the San Francisco VA Medical Center. We were the first at UCSF to ever do this type of DBS surgery, and now we’re the first VA in the country to do it.”

“For many years, if you were a Parkinson’s patient and you wanted to have DBS, there was only one option, the ‘awake’ surgery,” says Larson. “Now patients have a choice: They can have the longer, traditional procedure, or they can have the ‘asleep’ MRI technique. At the end of the day these are both reasonable ways to implant electrodes. It comes down to patient preference. We’re happy that people have a choice.”