Auditory brain stem implants are infrequently encountered neuroprosthetic devices used for auditory rehabilitation in deaf patients with pathology between the cochlea and cochlear nuclei who would not benefit from cochlear implantation. This article reviews the device, the relevant anatomy, audiologic performance, operative approaches, and conditions in which auditory brain stem implants are indicated. The imaging appearance of auditory brain stem implants, including optimal lead positioning, and imaging safety considerations of the device are also discussed. Knowledge of the device can assist the radiologist in detecting postoperative complications and component malpositioning and in providing safe and effective imaging practices in patients with indwelling auditory brain stem implants.Learning Objective: To describe the auditory brain stem implant device, identify optimal lead positioning, and list indications for auditory brain stem implant placement.