와우이식술 시 발생한 뇌척수액 분출

Abstract

Background and Objectives：A cerebrospinal fluid (CSF) gusher during cochlear implantation can produce surgical difi-culties and postoperative life threatening morbidities such as meningitis. Authors reviewed cases of CSF gushers during cochlear implantation, and assesed the radiologic characteristics of CSF gushers. Subjects and Method：From November 198 to March 2004, 72 congenital deaf children with inner ear malformation underwent cochlear implantation in Seoul National Uni-bone HRCT and IAC MRI were reviewed retrospectively. Results：Eighty percent (12/15) of CSF gushers had cochlear malformation. One case with a common cavity (100% ), 6 of 15 cases of cochlear hypoplasia (32% ) and 5 of 27 cases of in-complete partition (18.5%) showed CSF gush. The total or a partial defect of the modiolus significantly increased the risk of CSF gush. During the surgery, promontory mucosa around the cochleostomy opening was removed by electrocauterization and Some aditional procedures such as mastoid or midle ear obliteration were performed in two patients with intractable CSF gush. No lumbar drains were used. Postoperative meningitis developed in one case 7 months after cochlear implantation without a history of CSF leak. However, there were no evidences of CSF leak in all cases during the postoperative folow-up period (3- 49 months, mean 24 months). Conclusion：Cochlear implant surgeons should be prepared to cope with CSF gusher during the evidence of modiolar defect.