Section: 
Otiology
OtiologyThree-dimensional volumetry in prediction of intraoperative cerebrospinal fluid leak in patients with enlarged vestibular aqueduct
S. B. Sugarova (1), V. E. Kuzovkov (2), A. S. Lilenko (3), D. S. Luppov (4), O. D. Balandina (5), G. V. Ivanov (6), Yu. S. Korneva (7)
(1), (2), (3), (4), (5), (6), (7) Saint Petersburg Research Institute of Ear, Throat, Nose, and Speech, Saint Petersburg, 190013, Russian Federation
UDK: УДК 616.282.35-007-089.166-06-003.282
DOI: https://doi.org/10.18692/1810-4800-2026-3-88-94
ABSTRACT
Abstract. Introduction. Enlarged Vestibular Aqueduct (EVA) is a frequently encountered developmental malformation of the inner ear, identified in patients with congenital sensorineural hearing loss. Although temporal bone CT and MRI remain the gold standard for confirming the diagnosis, issues concerning the accurate diagnosis of the vestibular aqueduct and the prediction of intraoperative complications continue to be debated. Intraoperative cerebrospinal fluid (CSF) leak (a.k.a. otoliquorrea) is a key risk during inner ear surgery in these patients. Traditional approaches rely on linear measurements of the vestibular aqueduct width, which inadequately account for its complex three-dimensional structure and can lead to interpretation errors. The potential of 3D reconstruction and volumetric analysis, providing a comprehensive spatial assessment of the structure, reducing errors, and improving predictive value regarding surgical risks, becomes relevant. Objective. To study the association between the volume of the vestibular aqueduct, calculated based on 3D reconstruction data, and the probability of intraoperative CSF leak in patients with EVA. Patients and methods. A retrospective analysis included 13 patients with verified isolated EVA based on temporal bone CT scans. For all cases, 3D reconstruction and volumetric assessment of the vestibular aqueduct were performed based on high-resolution CT images using 3D Slicer software for medical imaging. Patients were divided into groups based on the presence/absence of intraoperative CSF leak during surgery and its type. Results. In patients with EVA and registered intraoperative CSF leak, the vestibular aqueduct volume according to 3D volumetry was significantly higher than in patients without this complication. The 3D reconstruction method provided detailed visualization of the vestibular aqueduct anatomy. Conclusions. The volume of the vestibular aqueduct, determined by the 3D method, positively correlates with the risk of intraoperative CSF leak in EVA. This approach is positioned as a reliable diagnostic tool for the preliminary assessment of CSF leak risk, optimization of surgical strategy, and enhancement of surgical safety. Integrating 3D volumetry into clinical practice will improve treatment outcomes for patients with this anomaly.
Publication date:
16.06.2026
Keywords:
enlarged vestibular aqueduct, cerebrospinal fluid leak, otoliquorrea, 3D volumetry For citation:
Sugarova S. B., Kuzovkov V. E., Lilenko A. S., Luppov D. S., Balandina O. D., Ivanov G. V., Korneva Yu. S. Three-dimensional volumetry in prediction of intraoperative cerebrospinal fluid leak in patients with enlarged vestibular aqueduct. Russian Otorhinolaryngology. 2026;25(3):88-94. (In Russ.) https://doi.org/10.18692/1810-4800-2026-3-88-94