Q: Dr. VanSickle…I understand you have a Ph.D. in bioengineering and are a neurosurgeon. Please tell us what led you down this path.
A: I actually started as an engineer with a degree in Mechanical Engineering. While obtaining my bioengineering Ph.D., I realized that there were difficulties in the communication between physicians and engineers, which impeded progress in device design. My original intent was to help bridge these gaps by seeking medical education. When selecting a residency, I found that I identified most closely with Neurosurgeons many of whom also had advanced degrees or other well developed fields of interest.
Q: What particular area of neurosurgery is your specialty?
A: While I still perform general neurosurgery, I primarily specialize in cranial cases. The majority of these are Deep Brain Stimulation (DBS). The next most common category would be brain tumors.
Q: You will be bringing a Deep Brain Stimulation program to Sky Ridge..can you tell us what this is?
DBS is the insertion of leads into specific areas of the brain for the treatment of neurologic diseases including Parkinson's disease, Essential Tremor, Dystonia and even OCD.
Q: Describe the type of people who are candidates for this procedure.
A: For Parkinson's disease, individuals are candidates if they have any motor fluctuations due to their medications. These motor symptoms include slowness of movement, tremor, dyskinesia from the medications, freezing, rigidity or lack of facial expression. The current trend is to treat much earlier than before. There is definitely a window of opportunity as late in the disease the benefits are fewer and the surgery cannot be done once dementia has set in.
For Essential Tremor, DBS is used for individuals who have a tremor that interferes with their activities of daily living and is not sufficiently responsive to medications.
Q: Traditionally this procedure is performed while patients are awake, but you will be conducting the surgery while patients are asleep. What is the advantage of this?
A: More than 100,000 leads have been placed worldwide and the majority of these have been done while awake. However, we know that less than 10% of patients who could benefit from this procedure are actually opting for it. One of the reasons for this is obvious. Awake surgery is scary! The greatest surgery in the world isn't worth much if people don't use it. We still offer awake surgery, but most of our patients are choosing to have this performed while they are asleep. The key to performing asleep DBS is using direct image verification of the lead placement. This has been made possible by new miniature CT scanners designed to be placed in the operating room.
Q: How many centers are currently offering it in this way?
A: Including a Denver DBS Center at South Denver Neurosurgery, I know of five centers in the US and seven worldwide. We are very fortunate Sky Ridge is offering this service to the community.
Q: What can patients hope to gain from this procedure?
A: DBS should improve all of the motor symptoms of Parkinson's disease including tremor, slowness of movement, rigidity and facial expression. New evidence strongly suggests that DBS can reduce mortality over a 10-year period after the surgery versus those who don't get DBS. Essential Tremor patients should see a 90% reduction in their tremor.
Q: Share some patient comments about the procedure.
A: Multiple times I have heard the comment, "Thank you for giving my life back to me."
Q: Are there other applications for this procedure?
OCD and Dystonia are treated under a medical device exemption given how rare these diseases are. Patients should call us for more details about the inclusion criteria.