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Published on: February 29, 2020
Cerebrospinal fluid gusher in cochlear implant and its associated factors
Seyed Basir Hashemi1,2, Haleh Bozorgi1, Tayebeh Kazemi1,2
1Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Cochlear implants (CI) are generally safe, but cerebrospinal fluid (CSF) gusher can occur. Structural abnormalities in the cochlea, like common cavity malformation, increase the risk of this intraoperative complication.
Area of Science:
- Otolaryngology
- Neurosurgery
- Medical Imaging
Background:
- Cochlear implantation (CI) is a common procedure for severe to profound sensorineural hearing loss.
- Intraoperative cerebrospinal fluid (CSF) gusher is a known complication of CI surgery.
- Understanding risk factors for CSF gusher is crucial for patient safety.
Purpose of the Study:
- To investigate the association between patient factors and the occurrence of intraoperative CSF gusher during cochlear implantation.
- To identify specific cochlear structural abnormalities linked to CSF gusher.
Main Methods:
- A retrospective analysis of 394 patients undergoing primary cochlear implantation.
- Exclusion of patients with incomplete records or revision surgeries.
- Review of CT scan reports for structural abnormalities in patients who experienced CSF gusher.
Main Results:
- Cerebrospinal fluid (CSF) gusher occurred in 5.58% of the evaluated patients.
- Patients experiencing CSF gusher were more likely to have reported structural abnormalities on CT scans.
- Common cavity malformation and Mondini dysplasia were the most frequent abnormalities associated with CSF gusher.
Conclusions:
- Cochlear structural abnormalities are associated with an increased incidence of intraoperative CSF gusher in cochlear implant recipients.
- Common cavity malformation and Mondini dysplasia are identified as specific risk factors.
- Enhanced pre-operative imaging is recommended for patients with known cochlear abnormalities to anticipate and manage potential CSF gusher.
Abstract:
Introduction: Cochlear implants (CI) is considered a safe procedure with overall complication rate of 12.5% amongst adult and pediatric population. Cerebrospinal fluid (CSF) gusher is regarded as a common CI intraoperative complication.Objective: In this study, we determined the association between probable associated factors and occurrence of intraoperative CSF gusher.Method: In a retrospective survey, 394 patients with severe to profound sensorineural hearing loss who underwent primary cochlear implantation surgery were evaluated. Patients with incomplete electronic or manual file and those with revision, explantation or reimplantation surgery were excluded.Result: three hundred and ninety-four CI patients with a mean age of 8.74 ± 12.21 years were reviewed 49.62% of them were female. CSF gusher developed in 22 patients (5.58%). Patients with CSF gusher had more structural abnormalities in their CT scans' report. Common cavity malformation and Mondini dysplasia were the most common abnormal reports amongst those with intra-operative CSF gusher.Conclusion: In conclusion, cochlea structural abnormalities affect the incidence of CSF gusher in CI recipients. Common cavity malformation and Mondini dysplasia were associated with an increased incidence of CSF gusher. We insist on more precise pre-operative imaging of those with abnormal cochlea structures to provide the needed management.
