Successful use of electrosurgery in an occipitocervical fusion procedure in a patient with an established cochlear implant: illustrative case.

Abstract

Background: Neurotechnology is rapidly evolving, challenging surgeons to expand their expertise in managing patients with implanted devices. More than 700,000 persons use cochlear implants. Many others have implanted pacemakers and neuromodulation devices. Understanding electrosurgical interactions is critical for patient safety, yet the literature on this remains limited. Conventional electrosurgery, which uses high-frequency alternating current for hemostasis, is contraindicated in cochlear implant users due to the risk of electromagnetic interference (EMI). EMI can cause heating, component malfunction, or device failure. Despite shielding, induction currents and voltage surges may exceed device tolerance, posing risks.

Observations: While PlasmaBlade safety is documented in cardiac surgery, its use in neurosurgery is underreported. The authors present a case demonstrating its safe application during an occipitocervical fusion in a 17-year-old with an established cochlear implant. The PlasmaBlade enabled exposure without affecting implant integrity or auditory function.

Lessons: As neurotechnology becomes increasingly prevalent, using innovative safety strategies, including monitoring electromagnetic fields, and adopting refined technologies like the PlasmaBlade will be impactful. These advancements have the potential to improve patient outcomes and ensure safer care for individuals with implanted devices. https://thejns.org/doi/10.3171/CASE25167.