Endoscopic Third Ventriculostomy with Choroid Plexus Coagulation for Infant Hydrocephalus

Endoscopic third ventriculostomy with choroid plexus coagulation/cauterization (ETV-CPC) is a well-established technique for treating certain types of infant hydrocephalus-a significant global issue. Since its first use by Dr. Benjamin Warf in Uganda over 20 years ago, pediatric neurosurgeons around the world have incorporated it into their practices. The primary benefit of the technique is the avoidance of indwelling shunts, which carry upfront costs that can be prohibitive in many parts of the world, and unpredictable long-term failure rates that are undesirable in any setting. Questions remain, however, about the comparative efficacy of ETV-CPC versus shunt and the factors predicting success or failure. This chapter reviews the history of the technique's development to provide context for its inception; summarizes the literature on its use in different geographic and etiologic populations; and highlights gaps in our knowledge that warrant further investigation. In summary, ETV-CPC is a safe and effective technique in the management of some forms of infant hydrocephalus, but surgeons should consider individual patient characteristics and family preferences when deciding between endoscopic treatment versus a shunt.