Deep Brain Stimulation for Parkinson's Disease

The screws used in spine surgery are not absorbable — they remain in place lifelong. Financially, robotic-assisted spine surgery costs about $1,000 to $2,000 extra on top of a normal spine surgery of around $7,000, but the advantage is that screw misplacement drops to less than 1%, which is significant because a single misplaced screw can undermine the whole surgery — so while it adds cost, it also adds real value to the outcome.

Absolute contraindications include cardiac problems, any bleeding or coagulation disorders, or severe infection in the body. If a patient — for example with trigeminal neuralgia — is responding well to medication at a controllable dose, we will not operate; surgery is offered when the patient's pain is not relieved despite medical management.

There can be anaesthesia-related complications. On the surgical side, we can get a haematoma in the cerebellum, sometimes bleeding, sometimes infection, or damage to the nerves — though our infection rate is very low. One patient developed chemical meningitis leading to hydrocephalus and needed a shunt, but the rest did very well. Initially some patients complained of partial hearing loss from traction on the eighth nerve; now we use minimal traction, so results are good and complications are minimal.

Only about 5%, not more than that. In our setup we have done more than 100 surgeries and have not had to redo any; some patients may have mild symptoms that can be managed with medicine or reassurance, but otherwise the results are good.

We do endoscopic third ventriculostomy in paediatric congenital hydrocephalus, but success is slightly lower at a young age — around 70-80%. A programmable shunt has a 95% success rate, but shunt revision and infection are other factors to weigh; endoscopic third ventriculostomy is a better choice when it succeeds, since the chances of recurrence problems afterward are very low.

It is considered once medication is no longer responding well, significant side effects appear from higher doses, or quality of life becomes compromised, typically after the initial four to five year period when levodopa works well starts to wear off.

A stereotactic frame is applied to the head, the patient is kept awake during electrode placement so the team can confirm correct positioning by testing hand and leg movement, and a pacemaker-like device is placed under the chest wall skin connected to the electrode leads.

Patients typically see reduced medication requirements and significantly improved function; in one recent case, a patient with abnormal one-sided movement and difficulty standing did very well after the procedure.

Around 30,000 to 40,000 US dollars, reflecting the complexity and precision the procedure requires.