The Global Rise of Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Pediatric Hydrocephalus

Abstract

In the quest to identify the optimal means of cerebrospinal fluid diversion free of shunt dependency, endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has been proposed as a promising procedure in select children. Supplementing traditional ETV with obliteration of the choroid plexus has been shown to decrease the likelihood of ultimate shunt dependency by roughly 20%. Originally devised to treat hydrocephalus in infants in sub-Saharan Africa, ETV/CPC has gained eager attention and cautious support in the developed world. Herein, we offer a comprehensive review of ETV/CPC beginning with the history and theory behind the operation. Next, we delve into the data supporting its use across heterogeneous pediatric populations, and finally we discuss clinical outcomes and future directions.

Outcome of Choroid Plexus Cauterization with Endoscopic 3<sup>rd</sup> Ventriculostomy vs Ventricular Shunting in Management of Hydrocephalus Secondary to Neural Tube Defect

“…In another study, the combination of CPC increased the ETV success rate from 46% to 66% as well [15]. The combination of ETV/CPC was also reported to have success rate of about 52%-66% elsewhere [1,8,17]. The success rate in our series was 60% which is concomitant with the published series.…”

“…Combination of both ETV/CPC was established to enhance the efficacy and success rate of intervention. CPC can enhance the success rate of ETV through decreasing the CSF production based on the fact of the insufficient CSF absorption in infants [1,5,8]. Warf et al [5] in a series of 93 East African infantile patients with MMC who received ETV-CPC, the procedure demonstrated a success rate of 76% with no need for additional surgery (mean follow-up 19 months).…”

Myelomeningocele-associated hydrocephalus: nationwide analysis and systematic review

“…MMC characteristics such as dysplastic ventricular anomalies, increased ventricular floor thickness, huge massa intermedia, narrow foramen of Monro, or a narrow prepontine cistern with posterior fossa crowding are all cited characteristics that interfere with treatment success. 4,36 In our NIS data we hypothesized that ETV treatment would increase over the time period as this has been noted at individual centers, 12,64 but there was no change in ETV treatment over time when analyzed. It is possible that even though some centers have embraced an increase in ETV, these trends are lost when assessing the national trends, as many other centers have not adopted ETV.…”

Endoscopic Third Ventriculostomy with Choroid Plexus Coagulation for Treatment of Hydrocephalus in X-linked Myotubular Myopathy: A Novel Approach

“…It has been demonstrated that supplementing ETV with CPC decreases the likelihood of eventual shunt dependence by about 20% [7]. In a retrospective review of seven Hydrocephalus Clinical Research Network centers in North America, ETV/CPC in infants under two years of age with hydrocephalus was found to be reasonably safe [8].…”