DBS for Parkinson's disease: deep brain stimulation

1. 1 · Admission and anaesthesia

   The patient is admitted the day before the procedure (sometimes on the same day). They are taken to the operating theatre and surgery is performed under general anaesthesia, a feature that distinguishes us from many other centres where patients are kept awake.

2. 2 · Stereotactic frame · "cerebral GPS"

   After anaesthesia, the stereotactic frame is fixed, enabling electrode implantation along a trajectory planned with millimetre precision.

3. 3 · Incisions and implantation ★ No shaving

   Two minimal frontal incisions are made behind the hairline and, beneath them, two small burr holes through which the two electrodes are implanted at the selected target along the planned trajectories.

   ★ Dr. Pedro Roldán's differentiating approach

   The patient's hair is NOT shaved. The standard DBS technique at most centres requires shaving the entire head to place the stereotactic frame and open the surgical access points. Dr. Roldán has developed a proprietary protocol that allows the implant to be performed whilst preserving the patient's hair in its entirety. The patient leaves hospital with the same hair they arrived with, which is uncommon in functional neurosurgery and is something most patients greatly value.

4. 4 · Intraoperative verification

   Once implanted, a stereotactic CT scan of the brain is performed in the same surgical session to verify correct placement and to overlay the result with the planning images. If electrode deviation is 1 mm or more, it is repositioned in the same session without the need for a return to theatre.

5. 5 · Connection to the pulse generator

   Once correct implantation has been confirmed, the electrodes are tunnelled under the skin and connected to a compact pulse generator (similar in size to a cardiac pacemaker) that is housed beneath the right clavicle. Once current transmission has been verified, the procedure is complete (approx. 2-3 hours from induction of anaesthesia).

6. 6 · Recovery and post-operative CT

   A protocolised stay of 3-6 hours in the recovery unit, after which a post-operative brain CT confirms correct electrode placement and rules out complications such as post-surgical haemorrhage.

7. 7 · Hospitalisation and discharge

   On the first post-operative day the patient begins sitting and progressive mobilisation. On the second day they may shower, wounds are dressed, and discharge home is arranged. During the first week the system remains switched off and the patient continues their usual medication.

8. 8 · Switch-on and programming

   After 7 days the patient attends an outpatient appointment with the neurology and neurosurgery team, where the system is activated, initial programming takes place, and medication is adjusted according to the effects achieved. This appointment may be repeated 2 or 3 times until the optimum stimulation-medication balance is found. At that point a reduction of approximately 75% in usual medication is achieved.

When is DBS indicated for Parkinson's disease?

When medication is insufficient to control the symptoms caused by Parkinson's disease, it is the right moment to explore deep brain stimulation therapy. The ideal candidate has a good prior response to levodopa (positive pharmacological test) and no significant cognitive decline.

Multidisciplinary team

Our neurosurgery team works in close collaboration with an expert team in neurology and rehabilitation, creating a comprehensive care plan to optimise treatment before, during, and after surgery.

Informational video · DBS for Parkinson's disease

Multidisciplinary team specialised in DBS for Parkinson's disease patients.