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Association Between Cochlear Nerve Deficiency Grade and Cerebrospinal Fluid Gusher in Incomplete Partition Type I

Chang-Hee Kim1, Ngoc-Trinh Tran2,3, Jin Hee Han2,3

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|March 31, 2026
PubMed
Summary

Severe cochlear nerve deficiency (CND) on MRI significantly increases the risk of cerebrospinal fluid (CSF) gusher during cochlear implantation (CI) in incomplete partition type I malformations. Preoperative CND grading aids surgical planning for these cases.

Keywords:
Cerebrospinal fluid gusherCochlear implantationCochlear nerve deficiencyIncomplete partition type I

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Area of Science:

  • Neurosurgery
  • Radiology
  • Otolaryngology

Background:

  • Incomplete partition type I (IP-I) is a common inner ear malformation associated with cochlear implantation.
  • Cerebrospinal fluid (CSF) gusher during cochlear implantation (CI) is a potential complication, particularly in malformations.
  • Cochlear nerve deficiency (CND) is an imaging finding on MRI that may influence surgical outcomes.

Purpose of the Study:

  • To determine if preoperative MRI-based grading of cochlear nerve deficiency (CND) severity predicts the risk of cerebrospinal fluid (CSF) gusher during cochlear implantation (CI) in patients with incomplete partition type I (IP-I) malformation.

Main Methods:

  • Retrospective analysis of 12 ears from 10 patients with IP-I undergoing CI between 2020 and 2025.
  • CND severity was graded using internal auditory meatus (IAM) MRI: severe CND (IAM grade 2-3) versus mild/normal CND (IAM grade 4).
  • Intraoperative recording of CSF gusher and statistical analysis using Fisher exact test and Firth bias-reduced logistic regression.

Main Results:

  • CSF gusher occurred in 58.3% of cases (7 of 13 ears).
  • All ears with severe CND (5/5, 100%) experienced a CSF gusher, compared to 16.7% of ears with mild/normal CND (1/6).
  • A significant association was found between CND grade and CSF gusher (P=0.015), with severe CND showing substantially higher odds (OR=40.3).

Conclusions:

  • Increased severity of cochlear nerve deficiency (CND) on preoperative MRI is strongly correlated with a higher likelihood of CSF gusher in IP-I malformations.
  • CND grading on MRI can serve as a valuable tool for preoperative risk stratification.
  • This imaging marker assists in surgical planning for cochlear implantation in IP-I ears, potentially improving patient safety and outcomes.