Monday, April 28, 2014

Inside the Science of an Amazing New Surgery Called Deep Brain Stimulation


A neurosurgeon’s view during a brain operation: The head is held in place and covered with an adhesive drape containing iodine, which prevents infections and explains the orange tint.
The most futuristic medical treatment ever imagined is now a reality 

Like most people in need of major surgery, Rodney Haning, a retired telecommunications project manager and avid golfer, has a few questions for his doctors. He wonders, for example, exactly how the planned treatment is going to alleviate his condition, a severe tremor in his left hand that has, among other things, completely messed up his golf game, forcing him to switch from his favorite regular-length putter to a longer model that he steadies against his belly.

“Can anyone tell me why this procedure does what it does?” Haning asks one winter afternoon at UF Health Shands Hospital, at the University of Florida in Gainesville.

“Well,” says Kelly Foote, his neurosurgeon, “we know a lot, but not everything.”

The vague answer doesn’t seem to bother Haning, 67, an affable man who has opted for the elective brain surgery. And it’s hard to fault Foote for not going into greater detail about the underlying science, since he is, at that very moment, boring a hole in Haning’s skull.

“Can you hear the drill?” Foote asks his patient as he presses the stainless steel instrument against bone. When Haning, whose head is immobilized by an elaborate arrangement of medical hardware, asks why it doesn’t hurt to have a dime-size hole drilled in his skull, Foote calmly explains that the skull has no sensory nerve receptors. (The doctors numb his scalp before making the incision.)

The two continue to chat as Foote opens the dura—“It’s the water balloon that your brain lives in,” he says. “It’s sort of like a tough leather, for protection”—and exposes Haning’s brain.

Deep brain stimulation, or DBS, combines neurology, neurosurgery and electrical engineering, and casual conversations in the operating room between doctors and their wide-awake patients are just one of the surprises. The entire scene is an eerie blend of the fantastic and the everyday, like something from the work of Philip K. Dick, who gave us the stories that became Blade Runner and Total Recall. During surgery, DBS patients are made literally bionic. Tiny electrodes are implanted in their brains (powered by battery packs sewn into their chests) to deliver a weak but constant electric current that reduces or eliminates their symptoms. DBS can improve a shaky putting stroke; it can also help the disabled walk and the psychologically tormented find peace.

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