CSF Gusher Complication: Literature review on Cochlear Implants and Outcomes

Background Cochlear implantation is the primary treatment for severe to complete hearing loss, and though it is generally considered to be a safe procedure, there are some associated side effects. A CSF gusher is a notable side effect that involves profuse CSF leakage from the site of cochleostomy, particularly in patients with inner-ear malformations. The purpose of this review is to summarize the risks, complications, and treatment modalities of CSF gushers in cochlear implantation. Methods A literature review was conducted using PubMed. Studies ranged from 2015 to 2025. Inclusion criteria focused on studies discussing gusher complications in pediatric patients undergoing cochlear implant surgery. Studies involving non-human subjects, non-English publications, patients over 18 years old, or published prior to 2015 were excluded. Variables such as patient age and gender, clinical presentation, imaging findings, treatment options, and outcomes were recorded. Results CSF gusher complications during cochlear implant procedures remain a major concern in patients with primary inner ear malformations, particularly in conditions like Enlarged Vestibular Aqueduct Syndrome (LVAS), Mondini dysplasia, and incomplete partition types II and III (IP-II, IP-III). One article found cochlear dysplasia in 4 of 5 cases, while another reported 100% gusher occurrence in IP-III patients. Preoperative imaging—CT, HRCT, and MRI—is standard, though not always documented. Most cases linked gushers to cochlear dysplasia, hypoplasia, or wide internal auditory canals, though spontaneous gushers also occurred, indicating varied underlying causes. Conclusion Intraoperative findings are a better diagnostic measure of identifying the severity of CSF leaks compared to imaging. Autologous tissue sealing remains the gold standard for management with potential benefits from electrode modifications. Long-term outcomes are generally favorable, though some patients may need further intervention due to complications. Future research should focus on preoperative risk stratification, alternative treatment techniques, and long-term tracking of CSF gushers.