Choroid plexus coagulation in infants with extreme hydrocephalus or hydranencephaly

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Severe hydrocephalus and hydranencephaly are common congenital conditions in Kenya. In patients with these conditions, ventriculoperitoneal (VP) shunts are associated with appreciable complications and endoscopic third ventriculostomies (ETVs) have limited success. Endoscopic choroid plexus coagulation (CPC) to diminish CSF production is a potential treatment option. The purpose of this study was to evaluate the effect of CPC without ETV in infants with severe hydrocephalus or hydranencephaly.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Medical records of infants with severe congenital hydrocephalus or hydranencephaly who underwent CPC in Kijabe Hospital from November 2010 to April 2013 were reviewed retrospectively. Thirty-three patients with complete medical records and preoperative radiographic images were identified. After CPC, the infants were followed in the Kijabe Hospital outpatient department, in mobile clinics, or by telephone. Success of the CPC was defined as resolution of preoperative symptoms, stabilization of head size, and avoidance of VP shunt placement.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Patients were followed from 30 to 608 days (median of 120 days). Three patients were lost to follow-up. Of the 30 evaluable patients, CPC was considered to be successful in 13 (43.3%), including 8 of 20 patients with severe hydrocephalus and 5 of 10 with hydranencephaly. Failure of CPC was evident from increased head circumference in 14 (82%) of 17 patients and from CSF leakage in 3. Of the 17 failures, 13 occurred within 3 months of surgery. Six patients died: 3 whose CPC procedures were failures, 2 whose CPC was successful, and 1 postoperatively. Of the 17 in whom CPC failed, 10 subsequently underwent VP shunt insertion.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>CPC stabilizes macrocephaly in approximately 40% of infants with severe congenital hydrocephalus and hydranencephaly and can be considered as an alternative to VP shunt placement.</jats:p></jats:sec>

Hydranencephaly: Insights into Pathophysiology and Management

“…28,29 Shitsama and colleagues have shown good results in 50% (5 out of 10) of HE patients who underwent endoscopic choroid plexus ablation and did not need a VP shunt. 29 Surgical treatment should at least be proposed to the family of patients with severe intracranial hypertension giving them the possibility to choose this option. Medical management of epileptic fi ts, nutritional support and regular physiotherapy should be instituted.…”

Avoiding Complications in Endoscopic Third Ventriculostomy

“…Although success of ETV is comparable in infants and adults, it should be avoided in low birthweight and preterm patients due to poor results. 21 ETV and choroid plexus coagulation (CPC) is an effective and safe treatment for infant hydrocephalus, [22][23][24] especially in hydranencephaly or massive hydrocephalus. 25 ETV can be performed as an initial procedure for hydrocephalus in premature infants with intraventricular hemorrhage and hydrocephalus, obviating the need for a shunt in selected patients.…”

Coagulação endoscópica do plexo coroide no tratamento primário da hidranencefalia e da hidrocefalia extrema

“…Contudo, a coagulação endoscópica dos plexos coroides tem sido cada vez mais utilizada na tentativa de atingir esses objetivos com índices de morbimortalidade mais reduzidos. 1,4,5 A técnica para realização da coagulação de plexo coroide consiste em, com paciente sob anestesia geral e em posição supina neutra, realizar incisão semicircular na borda posterior da fontanela anterior ao nível da linha pupilar média e abrir pequena janela óssea seguida pela abertura longitudinal da dura-máter e introdução do neuroendoscópio rígido de zero grau. Posteriormente, são realizados o reconhecimento das estruturas cerebrais e a identificação do plexo coroide bilateralmente, utilizando como solução de irrigação o ringer simples.…”