Mangement Algorithm for CSF Gusher During Cochlear Implantation


The aim of this study was to assess the incidence of CSF gusher during cochlear implantation

in children with and without congenital inner-ear malformation and to establish a simple

stepwise algorithm for managing CSF gusher at the time of cochleostomy.

Materials and methods

A total of 54 congenitally deaf children were included in a retrospective study between January

2011 and December 2012. All cases underwent classical cochlear implantation surgeries

via mastoidectomy and posterior tympanostomy approach.


Nine patients developed gusher at the time of the cochleostomy. Among the nine cases, only

one child did not show any preoperative radiologic evidence of any bony cochleovestibular

malformation, whereas the remaining eight cases had different congenital inner-ear malformations

with known risk for intraoperative gusher during surgery.


We concluded that the CSF gusher is a surgical difficulty or an intraoperative challenge

rather than a bad prognostic determinate for the postoperative audiologic performance, and

in cases of congenital cochleovestibular malformation that develop gusher, a high degree of

congenital anomaly of the cochlea, and not the degree or the amount of gusher, is correlated

to the poor patient performance. Finally, we were able to achieve a simple stepwise algorithm

for the management of gusher during cochlear implantation.


cerebrospinal fluid gusher, cochlear implantation, common cavity malformation, large vestibular


aqueduct syndrome, wide internal auditory meatus

Posted by: ahmed mehanna, Associate Professor of ENT, Alexandria school of medicine, Egypt (19-Apr-2015)
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