Management of Cerebrospinal Fluid Leakage From Cochleostomy During Cochlear Implant Surgery

Objectives: The objectives of this retrospective review were to determine the incidence of cerebrospinal fluid (CSF) otorrhea from the cochleostomy during cochlear implant surgery, to recognize patients at risk, and to determine the appropriate preoperative, postoperative and intraoperative management. Methods: A chart review from two cochlear implant centers was performed to determine the incidence of CSF otorrhea, patients at risk, and appropriate management. Results: The incidence of CSF gusher is low, encountered in approximately 1% of patients undergoing cochlear implant surgery, and is seen in equal incidence in children and adults in our series. Preoperative imaging was predictive in only 50% of cases. Mechanisms for otorrhea in specific cochlear malformations and in those in which no apparent malformation exists are discussed. Successful implantation is expected in most cases. Intraoperative management may require complete packing of the middle ear space in addition to the cochleostomy to control CSF leak. Lumbar drain is rarely necessary. Outpatient management is possible in the majority of cases. Vaccination and antibiotic prophylaxis is essential. Conclusions: CSF otorrhea can be encountered in cochlear malformations and in cochleas without apparent malformation. Successful implantation without short‐term or long‐term complications is expected.