Management of cerebrospinal fluid gusher in pediatric cochlear implantation

Abstract

Management of cerebrospinal fluid gusher in pediatric cochlear implantation. Objectives: This study's aim is to evaluate the management of Cerebrospinal Fluid (CSF) gusher after cochlear implantation in children postoperatively.

Methodology: 120 children (age ranges 13 to 72 months) who underwent cochlear implantation and eight of them had CSF gusher intraoperatively. Successful cochlear implantations and intraoperative management performed by complete packing of the electrode around in cochleostomy with muscle for Case I to III. CSF gusher was observed in these cases postoperatively. Second and third look revision surgeries were performed. Also, fat tissue was used for the sealing of leakage in Case IV to VIII.

Results: Severe CSF gusher occurred in 6 children with the common cavity, moderate in one child with Incomplete Partition (IP) type 1 and mild in one child with normal cochlea. Sealing the cochleostomy with muscle performed in the first 3 children intraoperatively and they also had CSF gusher postoperatively. Revision surgeries were performed for 3 children. Sealing the cochleostomy with fat tissue was successful in Case I and II but not in Case III. Subtotal petrosectomy and obliteration of cavity with fat tissue had been performed for Case III. CSF leakage has not been seen in the other 5 children with fat tissue packing for the postoperative long term.

Conclusions: CSF gusher may occur in pediatric cochlear implantation with inner ear malformations postoperatively. Packing around the electrode in cochleostomy with muscle may not be enough. Fat tissue packing is more effective than muscle for the postoperative long term.