title: Deep Brain Stimulation in the Setting of Cochlear Implants: Case Report and Literature Review.
abstract: OBJECTIVE
  As technology continues to advance for our aging population, an increasing number of deep brain stimulation (DBS) candidates will have preexisting implanted electrical devices. In this article, we discuss safe and successful DBS in a patient with Parkinson's disease (PD) and bilateral cochlear implants.
  
  
  METHODS
  A 70-year-old male with PD and bilateral cochlear implants underwent successful microelectrode-guided DBS implantation into bilateral subthalamic nuclei (STN). The patient's cochlear implant magnets were removed and replaced in the outpatient clinic for preoperative MRI and stereotactic targeting. The cochlear implants were turned off intraoperatively for STN microelectrode recordings.
  
  
  RESULTS
  Precise, MRI-guided stereotactic DBS implantation was possible. Intraoperative high-fidelity microelectrode recordings confirmed STN neurons with the cochlear implants turned off. These recordings were not possible with active cochlear implant devices. Our literature review describes the other approaches/techniques that have been used to manage DBS surgery in the setting of cochlear implants.
  
  
  CONCLUSIONS
  Despite the risk of electrical interference between implanted medical devices, DBS and cochlear implants may be safe and compatible in the same patient if necessary precautions are taken.
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Va., USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Buell
authors.forename: Alexander
authors.initials: A
authors.lastname: Ksendzovsky
authors.forename: Binit B
authors.initials: BB
authors.lastname: Shah
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Kesser
authors.forename: W Jeffrey
authors.initials: WJ
authors.lastname: Elias
mesh_terms: D000368:Aged; D016477:Artifacts; D019929:Cochlear Implantation / Q000295:instrumentation / Q000379:methods*; D003054:Cochlear Implants; D046690:Deep Brain Stimulation; D020878:Device Removal; D004567:Electrodes, Implanted; D055590:Electromagnetic Phenomena; D004867:Equipment Design; D006319:Hearing Loss, Sensorineural / Q000150:complications / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008280:Magnetics / Q000295:instrumentation; D008297:Male; D008839:Microelectrodes; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology; D013788:Thalamus / Q000503:physiopathology