Deep brain stimulation (DBS), in other words, brain pacemaker surgery process is performed in two parts. After the first brain surgery, chest wall surgery is performed. The surgical processes are as follows:

• Brain Surgery: A stereotactic head frame is attached to the patient to keep the head stable during the procedure. In the next step, healthcare professionals map the brain through MRI and CT to identify areas of electrodes to be placed in the brain. Usually, electrodes are placed while the patient is awake to test the effectiveness of the electrodes.

During the operation, local anesthesia or general anesthesia is applied to the scalp of the patient. After anesthesia, the surgeon places a thin wire with electrodes into the patient's brain. In addition, a wire passes under the skin to a pulse generator (device battery) placed on the side of the collarbone.

During surgery, the surgeon and neurologist monitor the brain for electrode placement.

• Chest Wall Surgery: In the second part, which is the next stage of the surgery, the surgeon places the pulse generator (device battery) on the lateral (under the skin) part of the patient's collarbone. General anesthesia is used during this procedure. Wires from electrodes in the brain are placed under the patient's skin and routed to a battery-operated pulse generator.

A few weeks after surgery, the pulse generator in your chest kicks in. Doctor can easily program your pulse generator with the remote control. The amount of stimulation is customized to your situation and it may take up to four (4) to six (6) months to find the optimum setting.

Brain stimulation may be constant twenty-four (24) hours a day, or your doctor may recommend that you turn off your pulse generator at night and turn it back on in the morning, depending on your condition. You can turn the stimulation on and off with a special remote control to take home. In some cases, your doctor may program the pulse generator to allow you to make minor adjustments at home. Battery life of the generator varies with usage and settings. If the battery needs to be replaced, your surgeon will replace the generator during the outpatient procedure.

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