Endoscopic Third Ventriculostomy And Choroid Plexus Coagulation in Infants: Current Concepts and Illustrative Cases.

Abstract

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. 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. 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. 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. 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.