CSF gusher in cochlear implantation

Abstract

A cerebrospinal fluid (CSF) gusher during cochlear implantation can produce surgical difficulties and postoperative life-threatening morbidities such as meningitis. We reviewed our experiences of managing CSF gush during cochlear implantation, and assessed the radiologic characteristics of a CSF gusher. Seventy-two congenital deaf children with inner ear malformation underwent cochlear implantation in Seoul National University Children's Hospital from November 1988 to March 2004. Among these, 15 patients showed CSF gush intraoperatively. Total or partial defect of the modiolus increased the risk of CSF gush significantly. Dilated vestibular aqueduct and bulbous IAC showed no statistical significance. During surgery, the mucosa around the cochleostomy opening was removed and soft tissue plugs were packed alongside the active electrodes. Some additional procedures such as mastoid or posterior tympanic obliteration were performed in three patients with intractable CSF gush. No lumbar drain was used. Postoperative meningitis developed in one case after 7 months of implant usage; however, there was no evidence of CSF leak in all cases during the postoperative follow-up (1–47 months, mean 22 months). Surgeons should be prepared to cope with CSF gusher during cochlear implantation in cases with congenital inner ear malformation, particularly if the patient has radiological evidence of modiolar defect.