{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:29:10Z","timestamp":1788308950034,"version":"build-2803163510"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"24","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,12,15]]},"abstract":"\n BACKGROUND<\/jats:title>\n Deep brain stimulation (DBS) is an established treatment for Parkinson\u2019s disease (PD). Concurrently, brain tumors are increasing in incidence, creating complex clinical scenarios when both conditions coexist. The safety of delivering radiation therapy to patients with active DBS devices remains poorly documented, with limited guidelines available.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n This case report describes a 69-year-old male PD patient with bilateral DBS leads who developed metastatic melanoma with brain metastases. He underwent multiple radiation treatments, including stereotactic radiosurgery and hippocampal avoidance whole-brain radiation therapy, receiving a cumulative dose exceeding 47 Gy to the DBS device. Throughout treatment, the DBS device remained fully functional with no impedance changes or symptom deterioration. A review of similar cases indicates that radiation doses to DBS components, including leads and implantable pulse generators, are generally well tolerated, although no standardized safety protocols currently exist.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case reinforces the feasibility and safety of multiple radiation treatments in patients with implanted DBS devices when carefully planned and monitored. Cumulative high radiation doses may not impair DBS functionality, but attention to neutron contamination and dose distribution remains essential. Multidisciplinary collaboration and individualized planning are crucial to optimize tumor control while preserving device integrity in this emerging patient population.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25600<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25600","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:59:50Z","timestamp":1769083190000},"source":"Crossref","is-referenced-by-count":1,"title":["Radiation exposure to deep brain stimulation leads during multiple cranial radiation courses: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Adel","family":"Azghadi","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland"},{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3444-8665","authenticated-orcid":true,"given":"Kyle","family":"O\u2019Carroll","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland"},{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley K.","family":"Perlow","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland"},{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9123-136X","authenticated-orcid":true,"given":"Michael D.","family":"Staudt","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland"},{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"bib1","series-title":"N Engl J Med","first-page":"896","article-title":"A randomized trial of deep-brain stimulation for Parkinson\u2019s disease","volume":"355","author":"Deuschl","year":"2006","unstructured":"Deuschl GSchade-Brittinger CKrack PA randomized trial of deep-brain stimulation for Parkinson\u2019s disease. N Engl J Med. 2006;355(9):896-908."},{"issue":"1","key":"bib2","series-title":"JAMA","first-page":"63","article-title":"Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial","volume":"301","author":"Weaver","year":"2009","unstructured":"Weaver FMFollett KStern MBilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA. 2009;301(1):63-73."},{"key":"bib3","series-title":"Prog Brain Res","first-page":"311","article-title":"Deep brain stimulation state of the art and novel stimulation targets","volume":"184","author":"Ponce","year":"2010","unstructured":"Ponce FALozano AM.Deep brain stimulation state of the art and novel stimulation targets. Prog Brain Res. 2010;184:311-324."},{"issue":"3","key":"bib4","series-title":"J Neurooncol","first-page":"567","article-title":"Cancers of the brain and central nervous system: global patterns and trends in incidence","volume":"172","author":"Filho","year":"2025","unstructured":"Filho AMZnaor ASunguc CCancers of the brain and central nervous system: global patterns and trends in incidence. J Neurooncol. 2025;172(3):567-578."},{"issue":"1","key":"bib5","series-title":"Br J Neurosurg","first-page":"107","article-title":"Preventing radiotherapy-induced side effects on deep brain stimulators: the need for a multidisciplinary management","volume":"28","author":"Guy","year":"2014","unstructured":"Guy JBLevy AMalkoun NChargari CBigot LMagn\u00e9 N.Preventing radiotherapy-induced side effects on deep brain stimulators: the need for a multidisciplinary management. Br J Neurosurg. 2014;28(1):107-109."},{"issue":"3","key":"bib6","series-title":"Neurol Neurochir Pol","first-page":"280","article-title":"Radiation therapy in patients with implanted deep brain stimulation","volume":"54","author":"Schinwelski","year":"2020","unstructured":"Schinwelski MJDulski J\u0141uczak WLibionka WMandat TS\u0142awek J.Radiation therapy in patients with implanted deep brain stimulation. Neurol Neurochir Pol. 2020;54(3):280-283."},{"issue":"4","key":"bib7","series-title":"J Neurosurg","first-page":"966","article-title":"Report of whole-brain radiation therapy in a patient with an implanted deep brain stimulator: important neurosurgical considerations and radiotherapy practice principles","volume":"124","author":"Kotecha","year":"2016","unstructured":"Kotecha RBerriochoa CAMurphy ESReport of whole-brain radiation therapy in a patient with an implanted deep brain stimulator: important neurosurgical considerations and radiotherapy practice principles. J Neurosurg. 2016;124(4):966-970."},{"issue":"6","key":"bib8","series-title":"Adv Radiat Oncol","first-page":"1380","article-title":"Case report: adjuvant breast cancer radiation therapy in a patient with an implanted deep brain stimulation device","volume":"5","author":"Tran","year":"2020","unstructured":"Tran MNMalkoske KEQuinn PMing CTam T.Case report: adjuvant breast cancer radiation therapy in a patient with an implanted deep brain stimulation device. Adv Radiat Oncol. 2020;5(6):1380-1383."},{"issue":"3","key":"bib9","series-title":"Clin Oncol (R Coll Radiol)","first-page":"e136","article-title":"Deep brain stimulators and radiation therapy in cancer patients","volume":"34","author":"Mushonga","year":"2022","unstructured":"Mushonga MKwan JYYPurdie TGDeep brain stimulators and radiation therapy in cancer patients. 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Br J Neurosurg. 2014;28(1):107-109."},{"issue":"3","key":"bib6","series-title":"Neurol Neurochir Pol","first-page":"280","article-title":"Radiation therapy in patients with implanted deep brain stimulation","volume":"54","author":"Schinwelski","year":"2020","unstructured":"Schinwelski MJDulski J\u0141uczak WLibionka WMandat TS\u0142awek J.Radiation therapy in patients with implanted deep brain stimulation. Neurol Neurochir Pol. 2020;54(3):280-283."},{"issue":"4","key":"bib7","series-title":"J Neurosurg","first-page":"966","article-title":"Report of whole-brain radiation therapy in a patient with an implanted deep brain stimulator: important neurosurgical considerations and radiotherapy practice principles","volume":"124","author":"Kotecha","year":"2016","unstructured":"Kotecha RBerriochoa CAMurphy ESReport of whole-brain radiation therapy in a patient with an implanted deep brain stimulator: important neurosurgical considerations and radiotherapy practice principles. J Neurosurg. 2016;124(4):966-970."},{"issue":"6","key":"bib8","series-title":"Adv Radiat Oncol","first-page":"1380","article-title":"Case report: adjuvant breast cancer radiation therapy in a patient with an implanted deep brain stimulation device","volume":"5","author":"Tran","year":"2020","unstructured":"Tran MNMalkoske KEQuinn PMing CTam T.Case report: adjuvant breast cancer radiation therapy in a patient with an implanted deep brain stimulation device. Adv Radiat Oncol. 2020;5(6):1380-1383."},{"issue":"3","key":"bib9","series-title":"Clin Oncol (R Coll Radiol)","first-page":"e136","article-title":"Deep brain stimulators and radiation therapy in cancer patients","volume":"34","author":"Mushonga","year":"2022","unstructured":"Mushonga MKwan JYYPurdie TGDeep brain stimulators and radiation therapy in cancer patients. Clin Oncol (R Coll Radiol). 2022;34(3):e136-e138."},{"issue":"1","key":"bib10","series-title":"Clin Oncol (R Coll Radiol)","first-page":"82","article-title":"Radical radiation therapy in a patient with head and neck cancer and severe Parkinson\u2019s disease","volume":"18","author":"Mazdai","year":"2006","unstructured":"Mazdai GStewart DPHounsell AR.Radical radiation therapy in a patient with head and neck cancer and severe Parkinson\u2019s disease. Clin Oncol (R Coll Radiol). 2006;18(1):82-84."},{"issue":"5","key":"bib11","series-title":"Pract Radiat Oncol","first-page":"294","article-title":"Delivery of definitive dose external beam radiation in close proximity to an implanted deep brain stimulator","volume":"4","author":"Borkenhagen","year":"2014","unstructured":"Borkenhagen JFMorris ZSHoberg JRKozak KRShapiro LQ.Delivery of definitive dose external beam radiation in close proximity to an implanted deep brain stimulator. Pract Radiat Oncol. 2014;4(5):294-297."},{"issue":"1","key":"bib12","series-title":"CSMC","first-page":"1","article-title":"Safe delivery of high-dose radiation therapy to an aggressive head and neck malignancy in a patient with deep brain stimulators","volume":"6","author":"Page","year":"2019","unstructured":"Page SMParis MIKelly LE.Safe delivery of high-dose radiation therapy to an aggressive head and neck malignancy in a patient with deep brain stimulators. CSMC. 2019;6(1):1-5."},{"issue":"12","key":"bib13","series-title":"Med Phys","first-page":"e757","article-title":"Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: a report of the AAPM TG-203\u2020","volume":"46","author":"Miften","year":"2019","unstructured":"Miften MMihailidis DKry SFManagement of radiotherapy patients with implanted cardiac pacemakers and defibrillators: a report of the AAPM TG-203\u2020. 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