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DHMC using robots to aid brain surgery

Damien Fisher

Robert Bourgeois was making a wedding cake for his niece when he first noticed the tremors.

“I just started shaking,” said Bourgeois, a retired quality technician. “I told my wife there’s something wrong.”

His tremors, first noticed in 2016, increased over time, and resulted in a loss of balance and a difficulty in walking. He went to see a doctor and got all the tests to rule out a stroke, and his condition continued.

Bourgeois continued to look for a cause and treatment for his tremors, but couldn’t find it. Then his doctor connected him with Dr. Joshua Aronson from Dartmouth-Hitchcock Medical Center. Aronson specializes in deep-brain stimulator surgery, in which small electric wires are placed in the brain, delivering electric signals to modulate brain activity.

Aronson said the survey is effective within minutes of the procedure.

“I feel taken aback when I see someone with such bad tremors. They cannot sign their name, and within seconds we make a significant change,” Aronson said.

Dartmouth-Hitchcock Medical Center is the only hospital in Northern New England that is using a robot to aid in the deep brain stimulator surgery, he said. In most other hospitals, patients undergoing the procedure need to have their heads placed in a clamp attached to the table. Because the surgeon wants to be able to fine tune the wire placement for effectiveness, the patients need to be awake for the three- or four-hour surgery.

Starting this fall, Aronson and Dartmouth-Hitchcock started using a small robot that’s attached to the patient’s head to guide the wires in. This allows patients to move their head during the surgery and not be clamped to the table.

“It’s so much more comfortable for the patient,” Aronson said.

The advantage to having the patient awake during the procedure is that it allows Aronson to make adjustments to the placement based on the patient’s response. Even a millimeter makes a difference, he said.

The procedures can be used for people with tremors from a variety of causes, including Parkinson’s disease.

Parkinson’s patients need adjustment to the signals and wire placement over time.

Bourgeois had heard about the possibility of dealing with his tremors though neurosurgery but had been hesitant.

“You just hear about fooling around with the brain. I just wasn’t comfortable with it,” Bourgeois said.

Aronson also uses MRI technology to perform the surgery on patients while they are asleep for those uncomfortable with undergoing the procedure while awake or unable to do so for medical reasons.

Aronson said the surgery is about returning function to people who were losing out on a normal life because of their tremors. They could not hold a coffee cup, or speak clearly because of their tremors.

“It’s life-changing surgery,” Aronson said.

Patients will have controllers implanted in their chests, similar to a pacemaker, which will need new batteries about once every five years.

Some of the newer controllers collect data on brain activity, Aronson said, which makes adjusting the electric signal easier to do.

Bourgeois got the surgery done in October, and his tremors are now gone.

“I would recommend it to anybody,” he said