CSF Gusher in Cochlear Implant Surgery-does it affect surgical outcomes?

Area of Science:

• Neurosurgery
• Otolaryngology
• Medical Device Technology

Background:

• Cochlear implant surgery carries risks, including cerebrospinal fluid (CSF) gusher, a potentially serious complication.
• Understanding and managing intraoperative CSF gusher is crucial for successful cochlear implantation outcomes.

Purpose of the Study:

• To evaluate surgical outcomes in patients experiencing cerebrospinal fluid gusher during cochlear implant procedures.
• To assess the efficacy of a specific management technique for intraoperative CSF gusher.

Main Methods:

• Prospective evaluation of nine patients with CSF gusher during 164 cochlear implant surgeries.
• Analysis of demographic, radiological, neurophysiological, and surgical data.
• Literature review and discussion of the authors' management strategy.

Main Results:

• Nine cases of intraoperative CSF gusher were identified.
• CSF gusher occurred in patients with incomplete partition type II and large vestibular aqueduct syndrome, as well as in cases with no identifiable risk factors.
• All nine cases were successfully managed with meticulous round window packing using periosteum, without lumbar drains or tissue glue.
• No postoperative CSF leak symptoms or signs were observed during follow-up.

Conclusions:

• Meticulous packing of the round window with periosteum is a recommended technique to control cerebrospinal fluid leaks during cochlear implant surgery.
• A conservative postoperative management approach is advised for patients who experience CSF gusher.