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Endoscopic Third Ventriculostomy And Choroid Plexus Coagulation in Infants: Current Concepts and Illustrative Cases
Ronnie E Baticulon1, Michael C Dewan2
1Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
Insights
Endoscopic third ventriculostomy combined with choroid plexus coagulation (ETV+CPC) offers a safe alternative to shunts for infant hydrocephalus. Appropriate patient selection, particularly for noninfectious cases, maximizes the chances of shunt independence.
Area of Science:
- Pediatric Neurosurgery
- Medical Technology
- Global Health
Background:
- Pediatric hydrocephalus presents a significant global health challenge, particularly in low- and middle-income countries.
- Ventriculoperitoneal shunting is a common treatment, but carries risks.
- Endoscopic third ventriculostomy combined with choroid plexus coagulation (ETV+CPC) has emerged as a promising shunt-sparing alternative.
Purpose of the Study:
- To provide an overview of ETV+CPC for treating infant hydrocephalus.
- To focus on critical aspects: patient selection, perioperative care, and long-term follow-up.
- To evaluate ETV+CPC as a viable treatment option for pediatric hydrocephalus.
Main Methods:
- Summarized observational studies and randomized trials on ETV+CPC efficacy and safety.
- Detailed equipment needs and operative steps for ETV+CPC.
- Presented illustrative cases with varying outcomes in infants.
Main Results:
- ETV+CPC success is highest in infants over 1 month with noninfectious hydrocephalus (e.g., aqueductal stenosis, myelomeningocele) and no prior shunt.
- Poor outcomes are associated with posthemorrhagic hydrocephalus or cisternal scarring.
- Most ETV+CPC failures occur within 3-6 months post-surgery.
Conclusions:
- ETV+CPC is an effective and safe alternative to ventriculoperitoneal shunting in selected infants.
- Further long-term studies on functional and neurocognitive outcomes are needed.
- Optimizing ETV+CPC use can help more children achieve shunt freedom.
Background:
The global burden of pediatric hydrocephalus is high, causing significant morbidity and mortality among children especially in low- and middle-income countries. It is commonly treated with ventriculoperitoneal shunting, but in recent years, the combined use of endoscopic third ventriculostomy (ETV) and choroid plexus coagulation (CPC) has enabled patients to live without a shunt.
Objective:
We aim to give an overview of ETV+CPC for the treatment of hydrocephalus in infants, focusing on patient selection, perioperative care, and long-term follow-up.
Methods And Material:
We summarize observational studies and randomized trials on the efficacy and safety ETV+CPC, mainly from Uganda and North America. The equipment needs and operative steps of ETV+CPC are enumerated. At the end of the article, three illustrative cases of infants who underwent ETV+CPC with differing outcomes are presented.
Results:
The likelihood of success following ETV+CPC is the highest among infants older than 1 month, those with noninfectious hydrocephalus (e.g., aqueductal stenosis and myelomeningocele), and those previously without a shunt. Poor outcomes are seen in patients with posthemorrhagic hydrocephalus or evidence of cisternal scarring. Failure of ETV+CPC most commonly occurs within 3-6 months of surgery.
Conclusions:
ETV+CPC is an effective and safe alternative to ventriculoperitoneal shunting in appropriately selected infants with hydrocephalus. Long-term studies on functional and neurocognitive outcomes following ETV+CPC will help guide clinicians in decision making, allowing as many children as possible to attain shunt freedom.
