The brain pacemaker is implanted by a functional stereotactic neurosurgeon. This means that a stereotactic head frame is used to keep the patient’s head still during surgery and the neurosurgeon uses special imaging techniques, such as magnetic resonance imaging (MRI) or computed tomography (CT), to map the brain and locate the position of the site to be stimulated.
 
There are two parts to the surgery: the procedure to implant the leads and the surgery to implant the neurostimulator(s) and extensions. The patient is usually awake for the first part, during the placement of the leads, so that dialogue with the surgeon can establish precisely which part of the brain is being passed. For the second part, when the surgeon runs the extensions and positions the neurostimulator (generally in the chest wall), the patient is fully anesthetized. The length of surgery will depend upon whether one or two leads are to be placed in the brain. Some surgeries last up to five hours or more.