Parkinson Surgeries (DBS/MRI-FUS)

DBS: Under stereotactic frame or frameless navigation with intra-operative MRI/CT, the surgeon drills two small burr holes and advances microelectrodes into the STN/GPi/Vim, confirming the target by microelectrode recording and test stimulation (sometimes with the patient awake). Permanent leads are anchored, tunnelled subcutaneously and connected to a pulse generator implanted in the chest wall under general anaesthesia. MRgFUS: The patient lies in an MRI scanner with a helmet transducer; the operator delivers escalating ultrasound sonications to the Vim while monitoring tremor response and MR thermometry, creating a small ablative lesion at therapeutic temperature.

1. 1Detailed neurological assessment, formal levodopa-challenge test and neuropsychology evaluation to confirm candidacy.
2. 2High-resolution brain MRI and CT for stereotactic planning.
3. 3Optimise Parkinson medications and treat any active infection; dental review for DBS.
4. 4Stop anticoagulants per neurosurgeon; informed consent on intracerebral haemorrhage and stimulation side effects.
5. 5For MRgFUS, hair shaving and scalp preparation; bladder catheterisation as the patient lies still in the scanner.

1. 1Day 0-1: Hospital stay overnight after DBS; MRgFUS patients often discharged same day or next day.
2. 2Days 1-7: Wound healing for DBS; mild headache, scalp tenderness and bruising common.
3. 3Week 2-4: Initial DBS device programming visit; MRgFUS patients reviewed for tremor response.
4. 4Months 1-3: DBS programming refined over several outpatient visits; medication is gradually adjusted.
5. 5Months 3-6: Stable stimulation settings reached; motor diaries demonstrate improvement.
6. 6Annual: Long-term follow-up, battery checks for DBS, repeat tremor assessment for MRgFUS.