Use of Monopolar Coagulation and Transcranial Stimulation During Surgery for Advanced Scoliosis in Patients with Cochlear Implants-Case-Based Review.

Abstract

Surgery of the thoracic and lumbar spine must employ monopolar electrical coagulation due to the necessity of bleeding control because alternative methods have too many limitations. The use of such electrocoagulation in cochlear implant (CI) users carries a high risk of damaging the assistive listening device. The objective of this paper is to present the management of 2 CI system users with advanced spinal curvature who required surgical treatment for scoliosis. A review of the literature was conducted on the use of medical procedures based on the conduction of electrical potentials within CI users. This paper presents 2 cases of surgery for spinal deformity in children who use CI. The precautions employed with regard to the utilization of monopolar coagulation are delineated. In neither case was damage to the CIs identified, despite the utilization of monopolar coagulation. A review of the literature revealed 415 documented instances of CIs being exposed to electrical current flow, of which 2 resulted in damage to the device. One case involved a patient who was defibrillated during cardiac arrest, while the other was related to dental pulp measurements on cadaveric teeth. Although monopolar electrocoagulation is considered a high-risk procedure for patients with CIs, this paper demonstrates that such procedures can be performed safely with appropriate precautions. It seems reasonable to conduct further experimental studies aimed at developing safe protocols to minimize the risk of damage to CI, ensuring that patients can undergo necessary medical procedures.