Why did we encounter gusher in a stapes surgery case? Was it enlarged medial aperture of the cochlear aqueduct?
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Why did we encounter gusher in a stapes surgery case? Was it enlarged medial aperture of the cochlear aqueduct? Bulent Satar1 · Hakan Genc1 · Salih Cengiz Meral1 Received: 24 June 2020 / Accepted: 15 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background and purpose Preoperative prediction of cerebrospinal fluid (CSF) gusher is important for stapes surgery. According to the current opinion settled among otologists and radiologists, the issues of whether enlarged cochlear aqueduct might be a cause of CSF gusher in stapes surgery and which segment of the aqueduct should be taken into account to diagnose enlarged cochlear aqueduct in computerized tomography (CT) are controversial. The case we encountered led us to hypothesize that enlarged cochlear aqueduct might cause CSF gusher in stapes surgery and that shape and diameter of medial aperture of the cochlear aqueduct are important in this prediction. Methods and results Enlarged medial aperture of the cochlear aqueduct with a shape differed from that of the other side was retrospectively diagnosed in thin-slice CT in a patient who had been undergone middle ear and stapes surgery for conductive hearing loss. This finding went unnoticed in preoperative CT. In the small fenestra stapedotomy operation, CSF gusher occurred through opening in the ill-defined, fixed and thickened stapes footplate. A piece of temporalis fascia and reshaped incus were appropriately placed which stopped the gusher. Re-evaluation of preoperatively taken CT showed that anterior–posterior and superior–inferior diameters of the medial aperture were 11.7 mm and 2.87 mm in CSF gusher side versus 2.95 mm and 1.88 mm on the other side, respectively. Its shape in gusher side differed from that of the other side. Conclusion This report is the first to show video-documented CSF gusher in a patient with enlarged medial aperture of the cochlear aqueduct. It appears to be plausible to propose that these findings have to change the otologists’ and radiologists’ perspective to the cochlear aqueduct. It can be deduced that difference in shapes of the medial aperture in both sides might be an indicator of potential CSF gusher. Keywords Cerebrospinal fluid gusher · Medial aperture of cochlear aqueduct · Otosclerosis · Small fenestra stapedotomy · Stapes surgery
Introduction Cerebrospinal fluid (CSF) gusher is a rare but devastating circumstance that may occur in stapes surgery. Therefore, prediction of CSF gusher preoperatively is important. Whereas consensus has been reached on the presence of anatomic defect and some other abnormalities in around Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00276-020-02602-8) contains supplementary material, which is available to authorized users. * Bulent Satar [email protected] 1
Department of Otorhinolaryngology, Head and Neck Surgery, Gulhane Medical School, University of Health Sciences, 06018 Etlik, Ankara, Turkey
internal auditory canal (IA
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