Direct measurement of cerebrospinal fluid pressure through the cochlea in a congenitally deaf child with Mondini dysplasia undergoing cochlear implantation.

OBJECTIVE

Perilymph/cerebrospinal fluid (CSF) "gushers" may occur at cochleostomy during cochlear implant surgery, particularly in patients with congenital cochlear duct malformation in which CSF in the internal auditory meatus is in direct communication with the perilymphatic space in the cochlea. The object of the study was to measure the pressure and flow of a CSF gusher at cochleostomy.

STUDY DESIGN

The design was a preoperative pressure measurement.

SETTING

The setting was a multidisciplinary cochlear implant program.

PATIENT

A 4-year-old girl with bilateral Mondini deformity undergoing cochlear implantation was studied.

INTERVENTION

A size 23 FG intravenous cannula was inserted into the cochlea and connected to a pediatric drip set to form an improvised manometer.

MAIN OUTCOME MEASURE

Intracochlear fluid pressure was measured at 14 cm H2O, equivalent to the normal CSF pressure that would be recorded in a child of this age at lumbar puncture. An indirect measurement of the likely size of the CSF/perilymph defect was made.

RESULTS

This technique may allow better assessment of the risk of postoperative CSF leakage and meningitis.

CONCLUSION

This simple technique of measuring the pressure in a perilymph gusher can be used to assess the need for careful sealing of the cochleostomy, to measure the reduction in pressure produced by head elevation or a spinal drain, and to assess the probable size of a defect in the lamina cribrosa.