Phacoemulsification in a patient with a deep brain stimulator

The local thermal effect of using monopolar electrosurgery in the presence of a deep brain stimulator: Cadaveric studies on a lamb brain

In 2001, a patient with a deep brain stimulator (DBS) died following treatment with medical diathermy. Manufacturers have since advised against all forms of diathermy except bipolar electrosurgery in DBS patients. This effective ban on monopolar electrosurgery has an impact on the 150,000 patients treated with DBS to date, a number that is set to progressively increase. Analysis of the events, technical specifications, and literature suggests that the original ban was based on extrapolation from medical diathermy to electrosurgery, two very different treatment modalities. This prompted novel work exploring the impact of electrosurgery on DBS systems. Monopolar electrosurgery was employed on an animal cadaveric model with a DBS system paired with a thermocouple at the brain implant site. Prolonged use of monopolar, including at settings higher than normal surgical practice, resulted in a maximum mean temperature increase of only 2.6 °C. Microscopic post-event analysis showed no evidence of thermal injury at the implant site. The implication is that there may be limits within which monopolar electrosurgery use is safe in patients with DBS.

Cataract surgery under topical anesthesia in a patient with Parkinson disease and deep brain stimulation: a report of feasibility

PURPOSE

Deep brain stimulation provides benefits for people with Parkinson disease by managing some of their complications. None of the few reports in the current literature establishes the functionality of deep brain stimulation when activated during phacoemulsification.

METHODS

A 70-year-old woman with subthalamic deep brain stimulator (DBS) for advanced Parkinson disease was referred to our center for cataract surgery. To evaluate any possible interference between ultrasounds and the DBS, we registered the impedance of the electrodes before and after surgery.

RESULTS

The patient underwent uneventful phacoemulsification of her right eye under topical anesthesia with her internal pulse generator device activated. During the surgical procedure, all potential variations of the impedance of the electrodes were recorded.

CONCLUSIONS

This report demonstrates that phacoemulsification under topical anesthesia is a feasible procedure in patients with DBS, showing no interference between the ultrasounds and the internal pulse generator.