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Choroid plexectomy for the treatment of chronic infected hydrocephalus
C Lapras1, P Mertens, J N Guilburd
1Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France.
Insights
Choroid plexectomy effectively sterilized cerebrospinal fluid (CSF) in most children with chronic infected hydrocephalus. This procedure arrested hydrocephalus in 37% of cases without requiring a shunt, offering a potential treatment option.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases in Children
- Cerebrospinal Fluid Dynamics
Background:
- Chronic infected hydrocephalus presents significant management challenges in pediatric patients.
- Traditional treatments may involve shunt placement, which carries risks of infection and malfunction.
- The role of the choroid plexus in cerebrospinal fluid production and infection propagation is a key consideration.
Purpose of the Study:
- To evaluate the efficacy and safety of choroid plexectomy as a primary treatment for chronic infected hydrocephalus in children.
- To assess the impact of choroid plexectomy on cerebrospinal fluid sterilization and hydrocephalus resolution.
- To analyze the incidence of seizures and neuropsychological outcomes post-procedure.
Main Methods:
- A cohort of 17 children with chronic infected hydrocephalus underwent choroid plexectomy via a direct open surgical approach.
- Cerebrospinal fluid (CSF) sterilization was monitored post-operatively.
- Hydrocephalus arrest, shunt requirement, seizure incidence, and neuropsychological outcomes were assessed.
- Choroid plexus removal was confirmed using scintigraphy.
Main Results:
- CSF sterilization was achieved in 16 out of 17 cases shortly after choroid plexectomy.
- Hydrocephalus arrested spontaneously without the need for a shunt in 37% of the children.
- The incidence of seizures did not increase following the procedure.
- Neuropsychological outcomes were suboptimal, potentially linked to the duration of chronic ventricular infection.
- The surgical mortality rate was 6%.
Conclusions:
- Choroid plexectomy is a viable treatment option for chronic infected hydrocephalus in pediatric populations.
- The procedure demonstrates high efficacy in sterilizing CSF and can lead to hydrocephalus arrest in a significant proportion of cases.
- While effective for infection control, long-term neurological outcomes warrant further investigation, especially in cases with prolonged illness.
Abstract:
Choroid plexectomy was performed for chronic infected hydrocephalus in 17 children via a direct open approach. In 16 cases, the CSF was sterilized soon after the plexectomy. In 37% of cases, the hydrocephalus was arrested without a shunt. The incidence of seizures did not increase after plexectomy. Removal of the choroid plexus was controlled by scintigraphy. Neuropsychological results were not encouraging, probably related to the long history of chronic ventricular infection. Surgical mortality was 6%. Choroid plexectomy should be considered as a possible treatment of chronic infected hydrocephalus in children.