Cerebrospinal fluid alterations following endoscopic third ventriculostomy with choroid plexus cauterization: a retrospective laboratory analysis of two tertiary care centers

  • Michael C. Dewan
  • Jonathan DallasEmail author
  • Shilin Zhao
  • Burkely P. Smith
  • Stephen Gannon
  • Fakhry Dawoud
  • Heidi Chen
  • Chevis N. Shannon
  • Brandon G. Rocque
  • Robert P. Naftel
Original Article



This study sought to determine the previously undescribed cytologic and metabolic alterations that accompany endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC).


Cerebrospinal fluid (CSF) samples were collected from infant patients with hydrocephalus at the time of index ETV/CPC and again at each reintervention for persistent hydrocephalus. Basic CSF parameters, including glucose, protein, and cell counts, were documented. A multivariable regression model, incorporating known predictors of ETV/CPC outcome, was constructed for each parameter to inform time-dependent normative values.


A total of 187 infants were treated via ETV/CPC for hydrocephalus; initial laboratory values were available for 164 patients. Etiology of hydrocephalus included myelomeningocele (53, 32%), intraventricular hemorrhage of prematurity (43, 26%), aqueductal stenosis (24, 15%), and others (44, 27%). CSF parameters did not differ significantly with age or etiology. Glucose levels initially drop below population average (36 to 32 mg/dL) post-operatively before slowly rising to normal levels (42 mg/dL) by 3 months. Dramatically elevated protein levels post-ETV/CPC (baseline of 59 mg/dL up to roughly 200 mg/dL at 1 month) also normalized over 3 months. No significant changes were appreciated in WBC. RBC counts were very elevated following ETV/CPC and quickly declined over the subsequent month.


CSF glucose and protein deviate significantly from normal ranges following ETV/CPC before normalizing over 3 months. High RBC values immediately post-ETV/CPC decline rapidly. Age at time of procedure and etiology have little influence on common clinical CSF laboratory parameters. Of note, the retrospective study design necessitates ETV/CPC failure, which could introduce bias in the results.


Glucose Protein Hydrocephalus Intraventricular hemorrhage Endoscopic third ventriculostomy Choroic plexus cauterization 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Dewan MC, Naftel RP (2017) The Global Rise of Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Pediatric Hydrocephalus. Pediatr Neurosurg 52:401–408. CrossRefPubMedGoogle Scholar
  2. 2.
    Kulkarni AV, Riva-Cambrin J, Browd SR et al (2014) Endoscopic third ventriculostomy and choroid plexus cauterization in infants with hydrocephalus: a retrospective Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr 14:224–229. CrossRefPubMedGoogle Scholar
  3. 3.
    Stone SSD, Warf BC (2014) Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series. J Neurosurg Pediatr 14:439–446. CrossRefPubMedGoogle Scholar
  4. 4.
    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 103:475–481. CrossRefPubMedGoogle Scholar
  5. 5.
    McAllister JP, Williams MA, Walker ML, et al (2015) An update on research priorities in hydrocephalus: overview of the third National Institutes of Health-sponsored symposium "Opportunities for Hydrocephalus Research: Pathways to Better Outcomes". J Neurosurg 123:1427–1438. doi: CrossRefGoogle Scholar
  6. 6.
    Harris PA, Taylor R, Thielke R et al (2009) Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. CrossRefGoogle Scholar
  7. 7.
    Thomson J, Sucharew H, Cruz AT et al (2018) Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture. Pediatrics 141:e20173405. CrossRefPubMedGoogle Scholar
  8. 8.
    Habiyaremye G, Morales DM, Morgan CD et al (2017) Chemokine and cytokine levels in the lumbar cerebrospinal fluid of preterm infants with post-hemorrhagic hydrocephalus. Fluids Barriers CNS 14:35–10. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Warf BC, Bhai S, Kulkarni AV, Mugamba J (2012) Shunt survival after failed endoscopic treatment of hydrocephalus. J Neurosurg Pediatr 10:463–470. CrossRefPubMedGoogle Scholar
  10. 10.
    Brydon HL, Hayward R, Harkness W, Bayston R (1996) Does the cerebrospinal fluid protein concentration increase the risk of shunt complications? Br J Neurosurg 10:267–273CrossRefGoogle Scholar
  11. 11.
    Pindrik J, Rocque BG, Arynchyna AA et al (2016) Radiographic markers of clinical outcomes after endoscopic third ventriculostomy with choroid plexus cauterization: cerebrospinal fluid turbulence and choroid plexus visualization. J Neurosurg Pediatr 18:287–295. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Michael C. Dewan
    • 1
  • Jonathan Dallas
    • 2
    Email author
  • Shilin Zhao
    • 3
  • Burkely P. Smith
    • 4
  • Stephen Gannon
    • 1
  • Fakhry Dawoud
    • 5
  • Heidi Chen
    • 3
  • Chevis N. Shannon
    • 1
  • Brandon G. Rocque
    • 6
  • Robert P. Naftel
    • 1
  1. 1.Department of NeurosurgeryVanderbilt University Medical CenterNashvilleUSA
  2. 2.School of MedicineVanderbilt UniversityNashvilleUSA
  3. 3.Department of BiostatisticsVanderbilt UniversityNashvilleUSA
  4. 4.Department of General SurgeryUniversity of Alabama-BirminghamBirminghamUSA
  5. 5.Quillen College of MedicineEast Tennessee State UniversityJohnson CityUSA
  6. 6.Department of NeurosurgeryUniversity of Alabama-BirminghamBirminghamUSA

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