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Choroid plexus coagulation in infants with extreme hydrocephalus or hydranencephaly

Sylvia Shitsama1, Nunthasiri Wittayanakorn, Humphrey Okechi

  • 1Division of Neurosurgery, Department of Surgery, Kijabe Hospital, Kijabe, Kenya.

Journal of Neurosurgery. Pediatrics
|April 29, 2014
PubMed

Insights

Endoscopic choroid plexus coagulation (CPC) stabilized severe hydrocephalus in 43.3% of infants in Kenya. This procedure offers a potential alternative to ventriculoperitoneal shunts for managing congenital hydrocephalus and hydranencephaly.

Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Medical Technology

Background:

  • Severe congenital hydrocephalus and hydranencephaly present significant challenges in Kenya.
  • Ventriculoperitoneal (VP) shunts have high complication rates, and endoscopic third ventriculostomies (ETVs) show limited efficacy in these patients.
  • Endoscopic choroid plexus coagulation (CPC) is explored to reduce cerebrospinal fluid (CSF) production.

Purpose of the Study:

  • To evaluate the effectiveness of CPC as a standalone treatment for infants with severe hydrocephalus or hydranencephaly.
  • To assess CPC's success in stabilizing head size and resolving symptoms without requiring VP shunt placement.

Main Methods:

  • Retrospective review of medical records for infants undergoing CPC at Kijabe Hospital (November 2010 - April 2013).
  • Inclusion criteria: severe congenital hydrocephalus or hydranencephaly, complete records, and preoperative imaging.
  • Success defined by symptom resolution, head size stabilization, and avoidance of VP shunt.

Main Results:

  • Thirty evaluable infants were followed for a median of 120 days.
  • CPC was successful in 43.3% of cases (13/30), including 8/20 with hydrocephalus and 5/10 with hydranencephaly.
  • Seventeen failures (56.7%) were observed, primarily due to increased head circumference (14/17) or CSF leakage (3/17), with 10 requiring subsequent VP shunt insertion. Six deaths occurred.

Conclusions:

  • CPC can stabilize macrocephaly in approximately 40% of infants with severe congenital hydrocephalus and hydranencephaly.
  • CPC presents a viable alternative treatment option to VP shunt placement in this patient population.
  • Further research may optimize CPC techniques and patient selection for improved outcomes.
Abstract

Keywords:
CPC = choroid plexus coagulationETV = endoscopic third ventriculostomyVP = ventriculoperitonealchoroid plexus coagulationhydranencephalyhydrocephalus

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