Deep brain stimulation is often performed with the help of a magnetic resonance imaging (MRI), which helps provide the clearest image of the brain. However, patients who have a pacemaker cannot undergo an MRI during the procedure if they ever need to get DBS treatment.
For such patients, DBS can be performed successfully with the help of a computed tomography (CT) scan, even though the quality of pictures of the brain is not that good. Thus, instead of optimal outcomes, the surgeon expects to get sub-optimal results at the start of the CT-guided DBS. This is discussed with the patient before the surgery.
Surgeons typically face a problem in placing leads in the specific areas of the brain in a CT-guided DBS treatment. This, in turn, affects the final outcomes in terms of stimulation treatment.
Another concern that the patients with pacemaker have before undergoing DBS treatment is about the placement of the stimulator. Typically, a pacemaker is placed in the same chest pocket as that of a DBS stimulator. However, if the pacemaker had been implanted first on the left side of the chest, the DBS stimulator can be placed in the same location toward the right side of the chest.
In some cases, the surgeon may decide to put the stimulator under the skin of the abdomen. This means that the length of the leads would dramatically increase, leading to an increased risk of lead fracture. But since the abdominal area has more padding, the stimulator and the leads are somewhat safe and do not protrude out from the skin.