title: CSF Gusher in Cochlear Implant Surgery-does it affect surgical outcomes?
abstract: OBJECTIVE
  The purpose of this prospective study was to measure surgical outcomes in cases of cerebrospinal fluid gusher in cochlear implant surgery.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Columbia Asia Hospital, PalamVihar, Gurgaon, Haryana, India. Electronic address: shankvdoc@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Vashist
authors.affiliation: Columbia Asia Hospital, PalamVihar, Gurgaon, Haryana, India; The ENT Clinic, A7 NeetiBagh, New Delhi 110049, India.
authors.forename: S
authors.initials: S
authors.lastname: Singh
mesh_terms: D065634:Cerebrospinal Fluid Leak / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D003054:Cochlear Implants; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors
keywords: Cerebrospinal fluid gusher; Cochlear implant; Inner ear malformation; Management; Round window