OBJECTIVE To discuss the clinical experience of prediction and management about perilymph gusher in cochlear implantation. METHOD Among 327 cases of cochlear implant, eleven recipients were selected by the high resolution computed tomography (HRCT) findings of cochlear malformations and bony fistula on fundus of the internal auditory canal that caused an abnormal connection between subarachnoid and perilymphatic spaces. RESULT Perilymph gusher was found in all of these 11 recipients during cochlear implantation and was controlled with muscle tissue seal. CONCLUSION The reason of perilymph gushers in cochlear implantation is that abnormal connection between subarachnoid and internal auditory canal. HRCT can be used to assess the possibility of perilymph gusher in surgery. The safe and rapid surgical method of gusher controlling can avoid complication.