Large acute posttraumatic epidural hematoma centered beneath a cochlear implant: A case report.

BACKGROUND: Cochlear implants provide substantial functional benefit to patients with severe sensorineural hearing loss. Management of acute intracranial hemorrhage adjacent to a functioning cochlear implant presents a unique challenge, requiring a balance between urgent neurosurgical intervention and preservation of implant integrity and auditory function. CASE DESCRIPTION: An 18-year-old male with congenital bilateral deafness and a right cochlear implant presented following a road traffic accident with severe headache and vomiting. Computed tomography demonstrated a large right parietotemporal acute epidural hematoma (EDH) centered directly beneath the cochlear implant receiver-stimulator. To minimize the risk of implant damage, a targeted burr-hole evacuation was performed two centimeters superior to the implant, using suction via a flexible nasogastric tube. Near-complete evacuation of the hematoma was achieved. Postoperatively, the patient made a full neurological recovery with preserved cochlear implant function. CONCLUSION: In selected cases of acute EDH adjacent to a functioning cochlear implant, a minimally invasive burr-hole approach may represent a safe and effective alternative to standard craniotomy, allowing hematoma evacuation while preserving implant function.