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Choroid Plexectomy for Hydrocephalus Management in a Pediatric Patient with a Pilocytic Astrocytoma
Reagan A Collins1, Brittany Tu1, Laszlo Nagy1
1Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas, United States.
Insights
Choroid plexectomy offers a shunt-independent solution for hydrocephalus in immunocompromised patients. This surgical option can prevent recurrent infections often associated with traditional shunt placements.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Oncology
Background:
- Hydrocephalus management, particularly in pediatric cases, often involves cerebrospinal fluid (CSF) shunting.
- Recurrent infections and shunt failures are significant challenges, especially in immunocompromised patients.
- Pilocytic astrocytoma can lead to hydrocephalus requiring complex management strategies.
Observation:
- A 2-year-old with hydrocephalus secondary to pilocytic astrocytoma presented with symptoms of shunt malfunction.
- The patient had a history of multiple shunt revisions and chemotherapy-induced neutropenia, increasing infection risk.
- The patient underwent choroid plexus coagulation and resection.
Findings:
- Following choroid plexectomy, the patient achieved shunt independence.
- The patient met neurodevelopmental milestones three years post-procedure.
- Choroid plexectomy demonstrated efficacy in managing hydrocephalus without shunt-related complications.
Implications:
- Choroid plexectomy should be considered as an alternative to shunting for hydrocephalus, particularly in immunocompromised pediatric patients.
- This approach may reduce the incidence of shunt-related infections and revisions.
- Further research into choroid plexectomy for complex hydrocephalus cases is warranted.
Abstract:
Choroid plexectomy is a debated surgical intervention for the treatment of hydranencephaly and chronic infected hydrocephalus. We present a case of a 2-year-old with multiple shunt revisions and hydrocephalus secondary to a pilocytic astrocytoma. He presented with new somnolence, vomiting, and abdominal distension 5 months post subtotal tumor resection, with a history of shunt revisions and infections related to his chemotherapy-induced low white blood cell count. He underwent choroid plexus coagulation and resection. Three years post choroid plexectomy, the patient continues to meet neurodevelopmental milestones and is shunt independent. While ventricular shunt placement is the most common course of treatment, choroid plexectomy should be considered as an alternative treatment of hydrocephalus secondary to other neurological disorders, especially when the patient is immunocompromised, to avoid the recurrent infections seen with shunt placement.
