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A stepwise algorithm for the management of cerebrospinal fluid 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.


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Correspondence to Ahmed Mohamed Ahmed Mehanna PHD.

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Mehanna, A.M.A., Fathala, M.F. & Elwany, M.S. A stepwise algorithm for the management of cerebrospinal fluid gusher during cochlear implantation. Egypt J Otolaryngol 31, 19–29 (2015).

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