Eddelman Daniel, Wewel Joshua, Wiet R Mark, Metman Leo V, Sani Sepehr
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Otolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Surg Neurol Int. 2017 Apr 5;8:47. doi: 10.4103/sni.sni_412_16. eCollection 2017.
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.
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.
Successful DBS implantation with high resolution MRI-guided targeting is technically feasible in patients with previously implanted cochlear implants by following proper precautions.
先前植入颅骨装置的患者在脑深部电刺激（DBS）手术中面临特殊挑战。我们报告了在一名植入人工耳蜗的患者中植入双侧DBS电极的情况。介绍了技术细节和设备间的长期功能。
一名70岁患有进展性帕金森病且先前因感音神经性听力损失植入人工耳蜗的患者，被转诊至丘脑底核（STN）进行双侧DBS植入。在进行DBS之前，患者接受了手术切除帽状腱膜下的耳蜗磁铁，随后进行立体定向MRI、框架放置、立体定向计算机断层扫描（CT）以及影像学研究的融合。该技术实现了成功的计算融合、MRI引导下的靶向定位以及电极植入，且精度可接受。两种设备的正式测试和编程均成功，未出现电干扰。
通过采取适当的预防措施，在先前植入人工耳蜗的患者中，采用高分辨率MRI引导靶向进行成功的DBS植入在技术上是可行的。
