Brain surgery. Rocket science. Getting the sticker off a CD case.

I was in the OR for brain surgery this morning. Okay, it wasn’t surgery on my brain; I was an observer.

I have been going to various hospitals and clinics for the past few days with several of my company’s field personnel. My goal is to gather input to improve our future products, particularly our so-called clinician and patient programmers. In order to do that, I have been watching our products get implanted, observing our reps interact with patients, and conversing with physicians about their therapies of interest. This morning was a deep brain stimulator implant.

People of all ages can be struck by movement disorders; they are not just ailments of the elderly. This morning’s patient was a 35-year old male with essential tremor (ET). ET generally presents itself as a low-frequency cyclic movement while a limb is active; in contrast, Parkisonian tremor is most prevalent while a limb is at rest. This patient’s tremor was pronounced enough that he could barely write his name and could produce only a scribble when asked to draw a spiral.

My company makes several products that are labeled for treatment of essential tremor. They work by stimulating the brain with electric pulses. In the case of essential tremor, they must stimulate the subthalamic nucleus, which is only a few millimeters on a side. If the stimulation is in the correct location, the tremors subside. If the stimulation is in the wrong part of the brain by even a few millimeters, there can be serious adverse effects.

I arrived at the hospital and put on some scrubs. I met my company’s rep and followed her through the maze-like bowels of the hospital to the OR that held the patient. I’m not sure why hospitals have to be so confusing; they almost never have adequate signage or straightforward layouts. The 20 ft by 30 ft OR was crowded with people and equipment. In contrast to other ORs that I’ve been in, there was no music playing. It was a bit on the cold side, but at least it was well lit.

The neurosurgeon was joined by a neurophysiologist and a number of support people. With the patient awake, the surgeon cut away two flaps of scalp; thanks to electrocautery, there was very little blood loss. I watched him drill two 14 mm holes in the patient’s skull and position a stereotactic frame for precise introduction of two leads into the brain. As the electrodes were lowered into the brain, brain waves appeared on a scope and played on a speaker. After the correct positions were located on each side of the brain, permanent electrodes were introduced and stimulation was switched on.

The effect was incredible. The patient lifted his hand and held it steady in the air. He wrote his name with impeccable penmanship. He drew marvelous spirals. He lifted a cup to his mouth. He accomplished all of this without any tremors. The patient was so happy that his eyes welled up with tears, and everybody in the OR shared in his joy.

Remarkable. A rocket launch would be hard pressed to beat what I saw today.