title: Successful implantation of a deep brain stimulator for essential tremor in a patient with a preexisting cochlear implant: surgical technique: technical case report.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) has become routine for the treatment of Parkinson's disease and essential tremor. Because both of these disorders are common in patients older than the age of 60, neurosurgeons are likely to encounter increasing numbers of patients who require DBS surgery but who already have another electronic medical implant such as a cardiac pacemaker/defibrillator or intrathecal infusion pump, raising the concern that one device might interfere with the performance of the other.
  
  
  METHODS
  Herein we report a modification of surgical technique resulting in the successful use of thalamic DBS to treat disabling essential tremor in a man with a previously implanted cochlear implant.
  
  
  METHODS
  The presence of the cochlear implant necessitated a number of modifications to our standard surgical technique including surgical removal of the subgaleal magnet that holds the receiver to the scalp and the use of computed tomography instead of magnetic resonance imaging to target the thalamus. More than a year after surgery, the patient is enjoying continued tremor suppression and an enhanced quality of life. The presence of the DBS device has not interfered with the proper functioning of his cochlear implant.
  
  
  CONCLUSIONS
  DBS can be used successfully in patients with a previously implanted cochlear implant. The operating neurosurgeon should be aware of the limitations of intraoperative imaging and the need to coordinate with an otologic surgeon for maximum patient benefit.
authors.affiliation: Department of Neurosurgery, The Mount Sinai Medical Center, New York, New York 10029, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: De Los Reyes
authors.forename: Sujana S
authors.initials: SS
authors.lastname: Chandrasekhar
authors.forename: Michele
authors.initials: M
authors.lastname: Tagliati
authors.forename: Ron
authors.initials: R
authors.lastname: Alterman
mesh_terms: D000368:Aged; D003054:Cochlear Implants / Q000009:adverse effects; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted / Q000592:standards; D020329:Essential Tremor / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D038361:Neuronavigation / Q000379:methods*; D019919:Prosthesis Implantation / Q000379:methods*; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome