Early outcome of combined endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Although shunts have been the mainstay in treating hydrocephalus over the past 5 decades, the use of endoscopic techniques in addressing this disorder in children offers both the neurosurgeon and the patient a unique opportunity to avoid shunting and its attendant complications. The combination of endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) remains uncommon in most centers despite its potential promise. The authors sought to investigate the efficacy of combining ETV and CPC (ETV+CPC) in treating childhood hydrocephalus in Nigeria. Infection and spina bifida contribute a high percentage of the cases of hydrocephalus in Nigeria.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Over a 2-year period, all children 0–18 years of age who had endoscopic treatment for hydrocephalus were prospectively evaluated to determine the need for subsequent treatment. Children who had the combination of ETV+CPC were identified as a subcategory and form the basis of this retrospective study.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Twenty-two of 38 endoscopically treated children had undergone the combination of ETV+CPC for hydrocephalus of varied etiology. There was a male preponderance (2.5:1), and 90% of the patients were infants. The overall success rate was 75%, with the best outcome in children with spina bifida. One child required a repeat ETV.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The combination of ETV+CPC is useful in treating children with hydrocephalus of varied etiology. The complication profile is acceptable, and the overall success rate is comparable to that associated with shunt insertion.</jats:p></jats:sec>

Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus

“…1,10,11,13,14,17,20,34,45 However, the mortality rate of 3.5% in our series is not negligible, and, although similar to that reported by Kulkarni et al (8.3%), 29 it is higher than mortality reported in series of infants undergoing ETV/ CPC in other North American centers (0%), 44 in Uganda (1.0%), and following ETV alone worldwide, where it is closer to 0%. 1,2,10,11,13,14,20,34,45 However, comparison between cohorts of patients undergoing ETV/CPC, ETV, or CSF shunting from different studies and centers is severely lim- ited by differences in the patient populations. Differences in mortality are likely heavily influenced by this selection bias, as patients undergoing ETV/CPC suffer from more complex underlying conditions (e.g., IVH of prematurity, hydranencephaly) than those undergoing standard ETV.…”

Comparative effectiveness of flexible versus rigid neuroendoscopy for endoscopic third ventriculostomy and choroid plexus cauterization: a propensity score–matched cohort and survival analysis

“…Both types of neuroendoscopes are used across centers in North America for ETV/CPC, with reported 12-month success rates ranging from 38% for rigid neuroendoscopy 20 to 57% for flexible neuroendoscopy. 8 In Africa, Asia, and Europe, both flexible neuroendoscopy 1,5,9,10,14,15,19 and rigid neuroendoscopy 2 have been used, with no consensus on the superiority of either technique. A retrospective review of ETV/CPC treatment outcomes from multiple North American centers participating in the Hydrocephalus Clinical Research Network suggested that greater extent of CPC and the use of a flexible neuroendoscope were associated with improved success, although the sample size was small and the patients were not randomized to neuroendoscopy type.…”

Management and Outcome of Infantile Hydrocephalus in a Tertiary Health Institution in Nigeria

“…[10,11] This series recorded a slight male preponderance in the incidence of hydrocephalus [ Table 1] with a male to female ratio of 1.3:1 which is similar to the reports in other parts of Nigeria and America. [10,[12][13][14] There was no obvious reason for this finding.…”