Abstract
Background
The traditional bulk flow model of communicating hydrocephalus does not support treatment by endoscopic third ventriculostomy (ETV), but successful treatment is reported in adults. This study is the first to report long-term success of ETV +/− choroid plexus cauterization (CPC) for infants with congenital idiopathic hydrocephalus (CIH). The results are interpreted in the context of current models for hydrocephalus.
Methods
The CURE Children’s Hospital of Uganda prospective database was reviewed for the years 2001–2006 to identify children <24 months of age meeting the criteria for CIH who underwent ETV with or without bilateral CPC. Kaplan–Meier method was used to assess treatment success survival. Gehan–Breslow–Wilcoxin and logrank tests were used to determine significance of survival differences. Fisher’s exact test was used to determine the significance of differences between groups.
Results
Sixty-four infants (mean/median age, 6.1/5.0 months) met the inclusion criteria. Sixteen consecutive patients were treated by ETV alone, and the subsequent 48 by ETV/CPC (mean/median follow-up 34.4/36.0 months). ETV was successful in 20 % and ETV/CPC in 72.4 % at 4 years (p < 0.0002, logrank test; p = 0.0006, Gehan–Breslow–Wilcoxin; hazard ratio 6.9, 95 % CI 2.5–19.3).
Conclusions
ETV/CPC was significantly more successful than ETV alone in treating CIH. The primary effect of ETV, as a pulsation absorber, and of CPC, as a pulsation reducer, may be to abate the net force of intraventricular pulsations that produce ventricular expansion. ETV alone may be less successful for infants because of greater brain compliance. ETV/CPC should be considered an effective primary treatment option.
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References
Greitz D (2007) Paradigm shift in hydrocephalus research in legacy of Dandy’s pioneering work; rationale for third ventriculostomy in communicating hydrocephalus. Childs Nerv Syst 23:487–489
Hailong F, Guangfu H, Haibin T, Hong P, Yong C, Weidong L, Dongdong Z (2008) Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study. J Neurosurg 109:923–930
Rangel-Castilla L, Barber S, Zhang YJ (2012) The role of endoscopic third ventriculostomy in the treatment of communicating hydrocephalus. World Neurosurgery 77(3/4):555–560
Singh I, Haris M, Husain M, Husain N, Rastogi M, Gupta RK (2008) Role of endoscopic third ventriculostomy in patients with communicating hydrocephalus: an evaluation by MR ventriculography. Neurosurg Rev 31(3):319–325
Griffith HB, Jamjoom AB (1990) The treatment of childhood hydrocephalus by choroid plexus coagulation and artificial cerebrospinal fluid perfusion. Br J Neurosurg 4(2):95–100
Morota N, Fujiyama Y (2004) Endoscopic coagulation of choroid plexus as treatment for hydrocephalus: indication and surgical technique. Childs Nerv Syst 20(11–12):816–820
Pople IK, Griffith HB (1993) Control of hydrocephalus by endoscopic choroid plexus coagulation—long-term results and complications. Eur J Pediatr Surg 3(1):17–18
Pople IK, Ettles D (1995) The role of endoscopic choroid plexus coagulation in the management of hydrocephalus. Neurosurgery 36(4):698–702
Scarff JE (1970) The treatment of nonobstructive (communicating) hydrocephalus by endoscopic cauterization of the choroid plexuses. J Neurosurg 33:1–18
Warf BC (2005) Hydrocephalus in Uganda: predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg 102:1–15
Warf BC (2005) Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. J Neurosurg 103(6 Suppl):475–481
Bateman GA, Smith RL, Siddique SH (2007) Idiopathic hydrocephalus in children and idiopathic intracranial hypertension in adults: two manifestations of the same pathophysiological process? J Neurosurg 107(6):439–444
Penn RD, Lee MC, Linninger AA, Miesel K, Lu SN, Stylos L (2005) Pressure gradients in the brain in an experimental model of hydrocephalus. J Neurosurg 102(6):1069–1075
Oi S, Di Rocco C (2006) Proposal of “evolution theory in cerebrospinal fluid dynamics” and minor pathway hydrocephalus in developing immature brain. Childs Nerv Syst 22:662–669
Bateman GA, Brown KM (2012) The measurement of CSF flow through the aqueduct in normal and hydrocephalic children: from where does it come, to where does it go? Childs Nerv Syst 28:55–63
Bateman G (2010) Hyperemic hydrocephalus: a new form of childhood hydrocephalus analogous to hyperemic intracranial hypertension in adults. J Neurosurg Pediatr 5(1):20–26
Bering EA (1962) Circulation of the cerebrospinal fluid. Demonstration of the choroid plexuses as the generator of the force for flow of fluid and ventricular enlargement. J Neurosurg 19:405–413
Egnor M, Zheng L, Rosiello A, Gutman F, Davis R (2002) A model of pulsations in communicating hydrocephalus. Pediatr Neurosurg 36:281–303
Wilson CB, Bertan V (1967) Interruption of the anterior choroidal artery in experimental hydrocephalus. Arch Neurol 17(6):614–619
Di Rocco C, Pettorossi VE, Caldarelli M, Mancinelli R, Velardi F (1978) Communicating hydrocephalus induced by mechanically increased amplitude of the intraventricular cerebrospinal fluid pressure: experimental studies. Exp Neurol 59(1):40–52
Pettorossi VE, Di Rocco C, Mancinelli R, Caldarelli M, Velardi F (1978) Communicating hydrocephalus induced by mechanically increased amplitude of the intraventricular cerebrospinal fluid pulse pressure: rationale and method. Exp Neurol 59(1):30–39
Wagshul ME, McAllister JP, Rashid S, Li J, Egnor MR, Walker ML et al (2009) Ventricular dilation and elevated aqueductal pulsations in a new experimental model of communicating hydrocephalus. Exp Neurol 218(1):33–40
Wagshul ME, Per K, Eide PK, Madsen JR (2011) The pulsating brain: a review of experimental and clinical studies of intracranial pulsatility. Fluids Barriers CNS 8(1):5
Warf BC, Tracy S, Mugamba J (2012) Long-term outcome for combined endoscopic third ventilculostomy and choroid plexus cauterization (ETV-CPC) compared to ETV alone for congenital aqueductal stenosis in African infants. J Neurosurg Pediatrics 10:108–111
Gangemi M, Maiuri F, Naddeo M, Godano U, Mascari C, Broggi G, Ferroli P (2008) Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus: an Italian multicenter study. Neurosurgery 63(1):62–67
Longatti PL, Fiorindi A, Martinuzzi A (2004) Failure of endoscopic third ventriculostomy in the treatment of idiopathic normal pressure hydrocephalus. Minim Invasive Neurosurg 47(6):342–345
Bateman GA (2008) The pathophysiology of idiopathic normal pressure hydrocephalus: cerebral ischemia or altered venous hemodynamics? Am J Neuroradiol 29(1):198–203
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Warf, B.C. Congenital idiopathic hydrocephalus of infancy: the results of treatment by endoscopic third ventriculostomy with or without choroid plexus cauterization and suggestions for how it works. Childs Nerv Syst 29, 935–940 (2013). https://doi.org/10.1007/s00381-013-2072-1
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DOI: https://doi.org/10.1007/s00381-013-2072-1