Related Experiment Video
Updated: Mar 8, 2026
Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation
Published on: February 29, 2020
Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral
Giacomo Colletti1, Marco Mandalà, Vittorio Colletti
1*Department of Maxillo-Facial Surgery, University of Milan †Otological and Skull Base Surgery Department, Azienda Ospedaliera Universitaria Senese, Siena ‡ENT Department, University of Verona, Verona §University of Firenze, Florence ||International Center for Performing and Teaching Auditory Brainstem Surgery in Children, Milan, Italy.
Insights
A child with cochlear nerve deficiency received bilateral auditory brainstem implants but developed CSF leaks. A novel cranioplasty technique successfully treated these leaks, preventing recurrence.
Area of Science:
- Neurosurgery
- Otolaryngology
- Pediatric Surgery
Background:
- Cochlear nerve deficiency (CND) presents significant challenges for hearing restoration.
- Auditory brainstem implants (ABI) offer a solution for profound hearing loss when cochlear implants are not feasible.
Observation:
- A 3.5-year-old child with CND and multiple congenital anomalies underwent simultaneous bilateral auditory brainstem implants (BS-ABI).
- Postoperatively, the child developed recurrent bilateral cerebrospinal fluid (CSF) leaks unresponsive to standard surgical revisions.
Findings:
- A novel rigid retrosigmoid cranioplasty technique utilizing autologous fat grafting and bioabsorbable meshes was performed.
- This intervention successfully sealed the dural breaches and secured the ABI receiver stimulators, resolving the CSF leaks.
- Post-procedure, no CSF leaks were observed at 60-day follow-up, and auditory brainstem responses confirmed ABI function.
Implications:
- Simultaneous bilateral craniotomies for BS-ABI may increase the risk of CSF leaks in pediatric patients.
- The described cranioplasty technique offers a potentially effective solution for managing complex CSF leaks post-neurosurgery.
- This approach may be beneficial for high-risk pediatric patients undergoing BS-ABI to prevent or treat CSF leaks.
Objective:
To present a child with cochlear nerve deficiency (CND) who received simultaneous bilateral simultaneous auditory brainstem implants (BS-ABI) and subsequently presented with bilateral cerebrospinal fluid (CSF) leaks unresponsive to standard treatments. To propose a novel rigid retrosigmoid cranioplasty for treating and preventing CSF leaks in children at high risk for this complication.
Patient:
A 3.5-year-old child with CND, vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities, coloboma, heart defect, atresia choanae, retarded growth and development, genital abnormality, and ear abnormality, Arnold Chiari malformation, previous treated tracheo-esophageal fistula underwent BS-ABI. Postoperatively, the child had recurrent bilateral retroauricular fluid collections. A standard revision procedure revealed breaches in the dural closure, migration of the auditory brainstem implantation (ABI) receiver stimulator on both sides and was unsuccessful in stopping the leak.
Interventions:
Bilateral repair with free fat grafting filling the craniectomy space and two absorbable meshes of poly-L-D-lactic (PLDL) acid stabilized with PLDL pins on the surrounding cranium, one to stabilize the fat graft and one to fix the ABI receiver stimulators inside the subperiosteal pockets.
Main Outcome Measure:
CSF leak recurrence, postoperative computed tomographic (CT) scans, intra- and postoperative simultaneous electrically evoked auditory brainstem responses (EABRs). Subjective and objective assessment of ABI function.
Results:
No postoperative CSF leaks at 60 days follow-up. EABRs and consistent behavioral responses obtained at initial mapping on both sides.
Conclusions:
The use of BS-ABI likely contributed to bilateral CSF leaks requiring revision surgeries in this child. Simultaneous bilateral craniotomies can put patients at risk for CSF leak. A novel cranioplasty technique employed finally proved successful in stopping the CSF leak in this case.
