Enlarged cochlear aqueducts: a potential route for CSF gushers in patients with enlarged vestibular aqueducts.
OBJECTIVE
We investigated whether the size of the cochlear aqueduct (CA) is increased in patients with enlarged vestibular aqueducts (EVAs) compared with individuals with normal inner ear anatomy. Furthermore, we assessed whether the size of the CA is related to the cerebrospinal fluid (CSF) gusher during cochlear implantation (CI) surgery.


METHODS
Retrospective study.


METHODS
Tertiary referral center.


METHODS
The medical records for 35 patients with a biallelic SLC26A4 mutation were reviewed. All of the patients were confirmed to have EVA by temporal bone computed tomography (TBCT) and biallelic SLC26A4 mutation by genetic analysis. Thirty-six age- and sex-matched patients without a mutation in the SLC26A4 gene were selected as comparison group.


METHODS
The diameters of the CA and vestibular aqueduct (VA) were measured, and the type of CA was evaluated using TBCT.


RESULTS
The CA was larger in patients with EVA (2.39 ± 0.99 mm) as compared with controls (1.76 ± 0.87 mm; p < 0.001). The types that could be most easily visualized from the subarachnoid space to the cochlea were more common in patients with EVA. Furthermore, mean CA size was significantly larger in EVA patients with CSF gushers (3.65 ± 1.12 mm) as compared with those without CSF gushers (2.03 ± 0.66 mm; p < 0.001).


CONCLUSIONS
The CA is a potential pathway for CSF gushers between the subarachnoid space and the inner ear. Therefore, we suggest that evaluation of the CA by TBCT may be helpful in predicting intraoperative CSF gushers in patients with EVA.
*Department of Otorhinolaryngology, Yonsei University, College of Medicine, Seoul; †Department of Biology, College of Natural Sciences, Kyungpook National University, Daegu; and ‡Department of Food and Nutrition, Yonsei University, Seoul, Republic of Korea.
Bo Gyung
BG
Kim
Nam Suk
NS
Sim
Sung Huhn
SH
Kim
Un-Kyung
UK
Kim
Soyeun
S
Kim
Jae Young
JY
Choi
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003052:Cochlear Aqueduct / Q000000981:diagnostic imaging / Q000601:surgery*; D019929:Cochlear Implantation / Q000379:methods*; D005260:Female; D005820:Genetic Testing; D006319:Hearing Loss, Sensorineural / Q000000981:diagnostic imaging / Q000235:genetics / Q000601:surgery*; D006801:Humans; D008297:Male; D026901:Membrane Transport Proteins / Q000235:genetics; D011859:Radiography; D012189:Retrospective Studies; D000076988:Sulfate Transporters; D016896:Treatment Outcome; D014723:Vestibular Aqueduct / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery
D026901:Membrane Transport Proteins; C085609:SLC26A4 protein, human; D000076988:Sulfate Transporters