Deep brain stimulation with a pre-existing cochlear implant: Surgical technique and outcome

Abstract

Background:Patients with previously implanted cranial devices pose a special challenge in deep brain stimulation (DBS) surgery. We report the implantation of bilateral DBS leads in a patient with a cochlear implant. Technical nuances and long-term interdevice functionality are presented.Case Description:A 70-year-old patient with advancing Parkinson's disease and a previously placed cochlear implant for sensorineural hearing loss was referred for placement of bilateral DBS in the subthalamic nucleus (STN). Prior to DBS, the patient underwent surgical removal of the subgaleal cochlear magnet, followed by stereotactic MRI, frame placement, stereotactic computed tomography (CT), and merging of imaging studies. This technique allowed for successful computational merging, MRI-guided targeting, and lead implantation with acceptable accuracy. Formal testing and programming of both the devices were successful without electrical interference.Conclusion:Successful DBS implantation with high resolution MRI-guided targeting is technically feasible in patients with previously implanted cochlear implants by following proper precautions.

Cochlear Implantation in a Patient with Implanted Trigeminus Stimulator—Clinical Considerations for Using Two Different Electrical Stimulators in the Same Patient and Our Results

“…The extraordinary case of cochlear implantation illustrated in this case report shows how complex it can be to check a CI indication. The existing trigeminal nerve stimulator system presented many obstacles (compare cases of CI and deep brain stimulator in one patient [24][25][26][27][28]). That the manufacturer of the trigeminal nerve stimulator system only allowed intracochlear stimulation by the CI system was challenging.…”