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Updated: Apr 1, 2026

Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation

Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation

Published on: February 29, 2020

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

Chang-Hee Kim¹, Ngoc-Trinh Tran^2,3, Jin Hee Han^2,3

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

Abstract

Objective:

To investigate whether the severity of cochlear nerve deficiency (CND) on preoperative MRI predicts the risk of cerebrospinal fluid (CSF) gusher during cochlear implantation (CI) in incomplete partition type I (IP-I) malformation.

Patients:

Between 2020 and 2025, 12 ears with IP-1 from 10 patients underwent CI at a single tertiary referral hospital.

Intervention:

CND was graded on internal auditory meatus MRI images (IAM grade 2 to 3 = severe CND; grade 4 = mild/normal). CSF gusher was recorded intraoperatively. Associations were analyzed using Fisher exact test and Firth bias-reduced logistic regression.

Main Outcome Measures:

CSF gusher was recorded intraoperatively. Associations were analyzed using Fisher exact test and Firth's bias-reduced logistic regression.

Results:

CSF gusher occurred in 7 of 13 ears (58.3%). All ears with severe CND (IAM Gr 2 to 3) exhibited gusher (5/5, 100%), whereas most ears with mild/normal CND (IAM Gr 4) did not (5/6, 83.3%). Fisher exact test showed a significant association between CND grade and CSF gusher ( P = 0.015). Firth logistic regression yielded an odds ratio of 40.3 (95% CI: 0.97-1669.4), indicating higher odds of CSF gusher in ears with severe CND.

Conclusions:

Greater CND severity on MRI correlates with increased likelihood of CSF gusher in IP-I malformation. CND grading may serve as a useful imaging marker for preoperative risk assessment and surgical planning in CI for IP-I ears.

Keywords:

Cerebrospinal fluid gusher Cochlear implantation Cochlear nerve deficiency Incomplete partition type I

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