Presurgical Rehearsals for Patients Considering "Awake" Deep Brain Stimulation

Abstract

Simulated surgical environments are rapidly gaining adoption in training students, residents, and members of specialized surgical teams. However, minimal attention has been given to the use of simulated surgical environments to educate patients on surgical processes, particularly procedures that require the active participation of the patient. "Awake" neurosurgery provides a unique situation in which patients openly participate in their operation. We describe a case report, in which a 62-year-old male was referred for "awake" deep brain stimulation implantation, in relation to medically refractory Parkinson's disease. The patient had significant concerns regarding anxiety and claustrophobia, and toleration of the "awake" procedure. Consequently, we designed a simulated OR environment and process, to recreate the physical experience of the procedure, with minimal cost or risk. This experience was crucial in determining the care plan, as after this experience, the patient opted for an "asleep" alternative. Thus, in certain settings, presurgical rehearsals may have a dramatic impact in the overall course of care.

Keywords: DBS; Parkinson’s disease; awake neurosurgery; patient experience; surgical simulation.

Figure 1

Cosman–Roberts–Wells (CRW) head frame used for rigid fixation to cranium for stereotactic neurosurgery. Frame is affixed to cranium via four screws placed through graphite posts (red arrows). Outer cage (black arrow) serves as a CT localizer for image registration.

Figure 2

Positioning of potential patient in CRW frame, prior to CT scanning.

Figure 3

Simulation of intraoperative CT scanning for image registration and DBS planning.

Figure 4

Simulated patient perspective of presurgical positioning, situated from within the CRW frame, prior to draping.

Figure 5

Surgical positioning after sterile draping. The sterile field is located behind the drape (not visualized), whereas the interactive patient space is located on the near side of the drape (visualized). This arrangement allows for the team to perform “awake” examination of the arms, legs, and face during deep brain stimulation.

Figure 6

Simulated patient perspective, after sterile draping, during the DBS procedure. The patient may experience this viewpoint for 4–6 h, as the surgery is being performed.