CSF Gusher in Cochlear Implant Surgery–does it affect surgical outcomes?

Abstract

a b s t r a c tObjectives: The purpose of this prospective study was to measure surgical outcomes in cases of cerebrospinal fluid gusher in cochlear implant surgery. Materials and methods: Demographic, radiological, neurophysiological and surgical results were evaluated in nine cases of patients with cerebrospinal fluid gusher during cochlear implant surgery, out of 164 unilateral cochlear implant procedures. Review of literature and our management technique is discussed. Results: Nine cases had cerebrospinal fluid leak during surgery. Out of three cases of incomplete partition type II, two had cerebrospinal fluid gusher while one had milder ooze. Two cases with large vestibular aqueduct syndrome had intraoperative cerebrospinal fluid gusher. Four cases of gusher had no predictable risk factors on clinical history, examination or preoperative radiology. All cases were managed with meticulous packing of round window site without any other additional measures such as lumbar drain or use of tissue glue. These cases showed no symptoms or signs of cerebrospinal fluid leak in the follow-up period. Conclusion: We recommend careful meticulous packing of the round window around the electrode using periosteum until cerebrospinal fluid leak is controlled in all cases of cerebrospinal fluid gushers. We also recommend a very conservative approach to managing these patients in the immediate postoperative period.

The Effects of Gusher-Related Intracochlear Pressure Changes on Hearing Preservation in Cochlear Implantation: A Comparative Series

“…CSF gusher increases the infection risk and the failure rate of surgery [Eisenman et al, 2001;Arnold et al, 2002;Sennaroglu, 2010;Hongjian et al, 2012;Vashist and Singh, 2016]; however, certain previous studies have not linked gusher to worse postoperative hearing outcomes [Lee et al, 2010;Adunka et al, 2012]. It has also been previously asserted, though not quantified, that gusher is associated with poorer speech understanding and poorer receptive vocabulary acquisition [Hongjian et al, 2012].…”

“…Though previously suggested as a cause of gusher, the cochlear aqueduct is likely not big enough to facilitate the volume of fluid egress associated with CSF gusher [Gopen et al, 1997;Tekdemir et al, 2000]. Similarly, it could be assumed that all of the patients in the nongusher group had an intact internal auditory canal and modiolus [Sennaroglu, 2010;Farinetti et al, 2014;Vashist and Singh, 2016].…”

Cochlear Implant Failure in the Pediatric Population

“…The CAP score is an index describing the highest typical level of functional hearing in everyday life. This scale can provide brief information about speech and conversation performance of CI patients [29]. Bhadania, et al [13] used CAP scale to interpret their results of CI revision surgery and found good performance in postoperative period.…”

Incidencia y manejo del gusher en la implantación coclear

“…Finalmente, otro aspecto de gran relevancia es el pronóstico, tanto en cuanto a la cirugía (morbilidad asociada) como al desempeño del paciente. En relación con el pronóstico quirúrgico, un trabajo realizado por Vashist 8 encontró que, en un grupo de nueve pacientes que presentaron gusher y que fueron manejados con sellado del sitio de cocleostomía con fascia y periostio, ninguno ameritó medidas extraordinarias para el manejo del gusher, y los autores concluyen que un sellado cuidadoso del sitio de cocleostomía y una vigilancia adecuada son suficientes para prevenir la morbilidad asociada al procedimiento quirúrgico. En lo que se refiere al desempeño del lenguaje de estos pacientes, hay que considerar que un porcentaje importante también presentan comorbilidad neurológica.…”