Q: What is the surgical procedure to install a brain pacemaker? Drs.: The brain pacemaker is a stereotactic procedure. After the pre-operative surgical safety assessment, efficacy prognosis, and psychological and cognitive assessments, suitable patients are ready for surgery. Generally, on the day of surgery, the patient will be fitted with a head frame and then enter the MRI room for an MRI. Yuquan Hospital has a very strong MRI center and has also developed new brain stereotactic image synthesis software in collaboration with Tsinghua University, which is combined with the patient’s cerebrovascular visualization to guide the surgeon to find the target of the surgery while avoiding damage to the cerebral vessels as much as possible. After the MRI is done on the day of surgery, it is officially time to go into surgery. During surgery, the surgeon will also perform neurophysiological point localization to determine if the target point is accurate by the firing of individual neurons. Accurate targeting is necessary to ensure the efficacy of the brain pacemaker. In addition, once the stimulation electrodes are placed at the target point, immediate results are seen. At this point, the patient is awakened and the accuracy of the target point can be determined by the improvement of the patient’s symptoms. In short, with these three items – imaging, neurophysiological monitoring, and intraoperative arousal at the time of healing – it is possible to ensure that the target point is as accurate as possible. Moreover, an intraoperative MRI will be done in the hospital to further determine if the location of the stimulation target is accurate, thus ensuring reliable and stable efficacy. Q: What kind of test is cerebrovascular visualization? Doctor: Generally speaking, before the installation of a brain pacemaker surgery, the images of the tissue structure of the brain need to be synthesized with the images of the brain blood vessels in order to find the target point more accurately and avoid damaging the brain tissue or blood vessels during the surgery. Therefore, the traditional preoperative MRI is to inject a contrast agent into the blood vessels in order to see the distribution of brain blood vessels. In contrast, cerebrovascular imaging, an imaging tool jointly developed by the Department of Neurosurgery, is a new type of cerebrovascular imaging technique that does not require contrast to see the distribution of blood vessels, including the distribution of arteries deep in the brain, minimizing intraoperative complications and avoiding the problem of patients’ intolerance to contrast. Q: What are the main parts of the consultation and treatment process for patients that you are responsible for? Doctor: I am responsible for the preoperative evaluation, intraoperative positioning, and postoperative regulation and management. Pre-operative evaluation includes clarifying the diagnosis and assessing the efficacy; intra-operative positioning includes identifying the target and testing the accuracy of the target; post-operative control includes the adjustment of equipment and medication. In addition, post-operative rehabilitation and psychological adjustment require seeking guidance from the neuropsychology and rehabilitation departments. In our hospital, we implement the first consultation system, and one doctor is responsible for the whole process from admission to discharge, so that any changes in patients can be detected and improved in a more timely manner. At the same time, the post-operative regulation allows us to have a good understanding of the patient’s remission status, assess the effect of the pacemaker, and detect abnormalities in a timely manner to ensure the best efficacy of the brain pacemaker. Q: What is the significance of the doctor’s full involvement for the patient? Doctor: The doctor’s participation in the whole process can better understand all aspects of the patient’s condition and detect any slight changes in the course of treatment. For example, some Parkinson’s patients have a long course of disease, and after surgery, they may be in a trance or even hallucinate, which may be difficult for their families to detect, but the doctor can detect these conditions and intervene in a timely manner to avoid the development of more serious problems through before and after comparisons.