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Evaluation of Cochlear Basal Turn Patency in Children with Hearing Loss
Marina Aramendi1, Mariana Raviolo2, Ina Sorge3
1Research Assistant at the Universitätsklinikum Leipzig, Leipzig, Germany. marinaaramendi@gmail.com.
Insights
Cochlear basal turn patency (CBTP) does not reliably predict intraoperative CSF gusher. Further research is needed to identify other contributing factors for this surgical complication.
Area of Science:
- Neurosurgery
- Otolaryngology
- Radiology
Background:
- Intraoperative CSF gusher, an abrupt leakage of cerebrospinal fluid (CSF), can occur due to cochlear basal turn patency (CBTP).
- Predicting intraoperative CSF gusher remains challenging due to a lack of established imaging techniques.
Purpose of the Study:
- To determine the prevalence, width, and anatomical variation of CBTP in pediatric patients with and without hearing loss.
- To assess the association between CBTP and the occurrence of intraoperative CSF gusher.
Main Methods:
- Retrospective review of high-resolution CT scans and medical records from 165 pediatric patients (330 ears).
- Patients were categorized into hearing loss and control groups.
- CBTP presence and size were measured using multiplanar reconstruction; incidence of intraoperative CSF gusher was recorded and correlated with CBTP width.
Main Results:
- CBTP was present in 44.2% of ears, with no significant difference between groups (p=0.06).
- Intraoperative CSF gusher occurred in 5.1% of cases, notably higher in ears with inner ear malformations (27.3%).
- CBTP exceeding 0.75 mm did not predict intraoperative CSF gusher (p=0.55); enlarged vestibular aqueduct was a significant malformation in patients with gusher (p<0.01).
Conclusions:
- Intraoperative CSF gusher necessitates reliable imaging predictors.
- CBTP alone is insufficient for predicting intraoperative CSF gusher, suggesting other factors are involved.
Purpose:
A patency at the cochlear basal turn (CBTP) can lead to an abrupt leakage of CSF, known as intraoperative CSF gusher. To date, there is no established technique for predicting an intraoperative CSF gusher. We aim to establish the prevalence, width and anatomical variation of CBTP in patients with and without hearing loss as well as to estimate its association between intraoperative CSF gusher.
Methods:
A retrospective review of high-resolution CT images and medical records from 165 pediatric patients (330 ears) was conducted (57 males/108 females). Patients were grouped based on audiometry results: a hearing loss group and healthy controls. The presence and size of CBTP was assessed using multiplanar reconstruction techniques. The incidence of intraoperative CSF gusher was recorded and correlated with the width of CBTP.
Results:
Cochlear basal turn patency was found in 44.2% of ears without significant differences between both groups (p = 0.06). Intraoperative CSF gusher occurred in 5.1% of cases, more frequently in ears with inner ear malformations (27.3%). A CBTP larger than 0.75 mm did not predict intraoperative CSF gusher (p = 0.55). Enlarged vestibular aqueduct was significantly the more common malformation in patients with intraoperative CSF gusher (p < 0.01).
Conclusion:
Intraoperative CSF gusher highlights the need for reliable imaging predictors. Yet, CBTP alone does not predict this phenomenon, indicating other contributing factors beyond known imaging findings.
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