ÃÛÌÒAPP
67-year-old retired sales rep Michael is at the Royal Victoria Infirmary for complex brain surgery.
Michael suffers from essential tremor which causes his hands to shake uncontrollably and makes many everyday tasks impossible. He explains: “My essential tremor was something that I inherited from my mother; she always had a tremor that was quite visible.
“I had a mild tremor which I managed to live with and work with, but I had a fall and dislocated my neck and so its exasperated the essential tremor. “
Today neurosurgeon Akar Hussain hopes to stop Michael’s hands from shaking and hopefully improve his quality of life. Akbar explains just how life-changing this surgery could be for Michael: “We do this operation called deep brain stimulation which means we put wires into the middle of the brain – in specific points – and then attach it to a stimulator which is a pacemaker that sits over the chest.
“Once you attach it to the pacemaker you can programme that to provide different levels of stimulation and build it up. Hopefully the tremor will disappear – its life changing.”
Akbar runs through some tests to see what Michael’s tremor looks like. Akbar asks Michael to lift a cup to his mouth – with one hand Michael can’t lift the cup to his mouth – but with two hands he can.
The goal is for him to be able to drink from the cup with one hand. Akbar asks Michael what he’d like to see after the surgery: “It’s the simple things – using cutlery, would be nice to be able to write. Read a paper without it moving around.”
It’s time for Michael’s surgery to begin.
The surgery is complex and the margins for error are so small – if you do go slightly wrong the outcomes for a patient can be life-changing.
Akbar needs to implant wires into Michal’s brain, he says: “The lead needs to be put to within a millimetre of my target – it needs to be precise – that’s where the x-rays come in as it confirms that I haven’t allowed it to move.”
Akbar must implant the wires perfectly into Michael’s brain to avoid having a catastrophic impact. “If I put the wite into the wrong place – I could change him, I could cause a stroke, cause a bleed he might not be able to communicate any more or he might be paralysed down one side.” Says Akbar.
With the wires in place its time for Akbar to attach them to the pacemaker in Michael’s chest. Once inserted Akbar needs to check the pacemaker is sending signals into Michael’s brain.
“One of the things that could happen now is that once we connect the wires in the brain to the battery, we need to check it’s all working correctly if it shows up that it’s not working correctly that would be a bit of a disaster worst case scenario, we might have to go back into the brain again.”
Akbar and the team check everything is working – all looks good so they can start the simulation – but this is where Akbar can start to feel anxious: “At this point it is a time where I do get anxious because you have to wait until the patient wakes up.
“Do they wake up and breathe for themselves, do they wake up and move all four of their limbs, in the back of my mind I’m thinking is he alright.”
After four hours its time for Akbar to check on Michael “We’ve done all the wiring all the technical bit has been done and we’re quite confident with that and we know it’s all working. Everything is where I want it to be but ultimately the thing now is to go and see the patient and even before knowing I’ve got a good effect from the DBS I want to know is he just as good now as he was before surgery so is he back to being the Michael that we saw beforehand.” Says Akbar.
Michael is feeling rough following surgery but it’s good to see him smile. Akbar now repeats some of the tests he did before the surgery to see how Michal’s tremor is now. He lifts both his hands “that’s a little bit better” say’s Michael.
Michael moves his hands to his face and there’s no tremor – even without turning it on they know everything is in the right place.
Michael’s brain implant has reduced his hand tremor and he’s now able to use a knife and fork at mealtimes.