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Combined Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization for Treatment of Infant Hydrocephalus

  • Benjamin C. WarfEmail author
Living reference work entry

Abstract

Current data suggest that combining ETV with CPC as the routine initial treatment for infant hydrocephalus could eliminate shunt dependence from the beginning in more than half of all patients regardless of etiology. The rationale for employing ETV/CPC as the frontline treatment for infant hydrocephalus is most compelling for low-income countries where shunt dependence is far more problematic than in the developed world, but the technique is being used increasingly in high-income countries as well. The technique is safe, and the infection rate is lower than that for shunt placement. Most failures occur within 6 months of surgery during the “safe zone,” when this is not a life-threatening emergency. The most important factors that determine success are patient age (with greater success in patients older than 6 months), extent of CPC, and the status of the prepontine cistern, with etiology being much less important. All etiologies of hydrocephalus (including infants with “communicating hydrocephalus”) are amenable to this treatment approach. Presently, there is no evidence that shunt placement is superior in regard to early childhood development. ETV/CPC is being increasingly used worldwide. The long-term neurocognitive, quality of life, and economic ramifications of ETV/CPC compared with shunt dependence as the primary treatment for infant hydrocephalus are important topics for future investigation.

Keywords

ETV/CPC Endoscopic third ventriculostomy Choroid plexus cauterization Infant hydrocephalus 

References

  1. Ames RH (1967) Ventriculo-peritoneal shunts in the management of hydrocephalus. J Neurosurg 27(6):525–529CrossRefGoogle Scholar
  2. Bankole OB, Ojo OA, Nnadi MN, Kanu OO, Olatosi JO (2015) Early outcome of combined endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus. J Neurosurg Pediatr 15(5):524–528CrossRefGoogle Scholar
  3. 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 19:405–413CrossRefGoogle Scholar
  4. Beuriat PA, Szathmari A, Grassiot B, Plaisant F, Rousselle C, Mottolese C (2016) Role of endoscopic third Ventriculostomy and choroid plexus cauterization in the management of myelomeningocele-related hydrocephalus: a retrospective study in a single French institution. World Neurosurg 87:484–493CrossRefGoogle Scholar
  5. Buxton N, Macarthur D, Mallucci C, Punt J, Vloeberghs M (1998) Neuroendoscopic third ventriculostomy in patients less than 1 year old. Pediatr Neurosurg 29:73–76CrossRefGoogle Scholar
  6. Dandy WE (1918) Extirpation of the choroid plexus of the lateral ventricles in communicating hydrocephalus. Ann Surg 68(6):569–579CrossRefGoogle Scholar
  7. Dandy WE (1919) Experimental hydrocephalus. Ann Surg 70(2):129–142CrossRefGoogle Scholar
  8. Dandy WE (1922) An operative procedure for hydrocephalus. Johns Hopkins Hosp Bull 33:189Google Scholar
  9. Egnor M, Zheng L, Rosiello A, Gutman F, Davis R (2002) A model of pulsations in communicating hydrocephalus. Pediatr Neurosurg 36:281–303CrossRefGoogle Scholar
  10. Guiot G (1973) Ventriculocisternostomy for stenosis of the aqueduct of sylvius. Puncture of the floor of the third ventricle with a leucotome under television control. Acta Neurochir 28:275–289CrossRefGoogle Scholar
  11. Hoffman HJ, Harwood-Nash D, Gilday DL (1980) Percutaneous third ventriculostomy in the management of non-communicating hydrocephalus. Neurosurgery 7(4):313–321CrossRefGoogle Scholar
  12. Kahle K, Kulkarny A, Limbrick D, Warf BC (2016) Hydrocephalus in children. Lancet 387(10020):788–799CrossRefGoogle Scholar
  13. Kapoor KG, Katz SE, Grzybowski DM, Lubow M (2008) Cerebrospinal fluid outflow: an evolving perspective. Brain Res Bull 77:327–334CrossRefGoogle Scholar
  14. Kelly PJ, Goerss S, Kall BA, Kispert DB (1986) Computed tomography-based stereotactic third ventriculostomy: technical note. Neurosurgery 18(6):791–794CrossRefGoogle Scholar
  15. Kulkarni AV, Riva-Cambrin J, Browd SR, Drake JM, Holubkov R, Kestle JR, Limbrick DD, Rozzelle CJ, Simon TD, Tamber MS, Wellons JC 3rd, Whitehead WE, Hydrocephalus Clinical Research Network (2014) Endoscopic third ventriculostomy and choroid plexus cauterization in infants with hydrocephalus: a retrospective hydrocephalus clinical research network study. J Neurosurg Pediatr 14(3):224–229CrossRefGoogle Scholar
  16. Kulkarni AV, Schiff SJ, Mbabazi-Kabachelor E, Mugamba J, Ssenyonga P, Donnelly R, Levenbach J, Monga V, Peterson M, MacDonald M, Cherukuri V, Warf BC (2017) Endoscopic treatment versus shunting for infant hydrocephalus in Uganda. N Engl J Med 377:2456–64CrossRefGoogle Scholar
  17. Mandell JG, Kulkarni AV, Warf BC, Schiff SJ (2015) Volumetric analysis in neurosurgery: part 2. Brain and CSF volumes discriminate neurocognitive outcomes in hydrocephalus. J Neurosurg Pediatr 15(2):125–132CrossRefGoogle Scholar
  18. Marano PJ, Stone SSD, Mugamba J, SSenyonga P, Warf EB, Warf BC (2015) Reopening of obstructed third ventriculostomy. Long-term success and factors affecting outcome in 215 infants. J Neurosurg Pediatr 15:399–405CrossRefGoogle Scholar
  19. Mixter WJ, (1923) Ventriculoscopy and puncture of the floor of the third ventricle. Preliminary report of a case. Boston Med Surgery J 188:277–278CrossRefGoogle Scholar
  20. Ogiwara H, Uematsu K, Morota N (2014) Obliteration of the choroid plexus after endoscopic coagulation. J Neurosurg Pediatr 14:230–233CrossRefGoogle Scholar
  21. 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 22:662–669CrossRefGoogle Scholar
  22. Perlman BB (1968) Percutaneous third ventriculostomy in the treatment of a hydrocephalic infant with aqueduct stenosis. Int Surg 49(5):443–448PubMedGoogle Scholar
  23. Pindrik J, Rocque BG, Arynchyna AA, Johnston JM, Rozzelle CJ (2016) Radiographic markers of clinical outcomes after endoscopic third ventriculostomy with choroid plexus cauterization: cerebrospinal fluid turbulence and choroid plexus visualization. J Neurosurg Pediatr 13:1–9Google Scholar
  24. Pople IK, Ettles D (1995) The role of endoscopic choroid plexus coagulation in the management of hydrocephalus. Neurosurgery 36:698–702CrossRefGoogle Scholar
  25. Putnam TJ (1934) Treatment of hydrocephalus by endoscopic coagulation of the choroid plexus: description of a new instrument and preliminary report of results. N Engl J Med 210(26):1373–1376CrossRefGoogle Scholar
  26. Sayers MP, Kosnik EJ (1976) Percutaneous third ventriculostomy: experience and technique. Childs Brain 2(1):24–30PubMedGoogle Scholar
  27. Scarff JE (1942) Nonobstructive hydrocephalus. Treatment by endoscopic cauterization of the choroid plexuses. Am J Dis Child 297-334(1942):63Google Scholar
  28. Scarff JE (1951) Treatment of obstructive hydrocephalus by puncture of the lamina terminalis and floor of the third ventricle. J Neurosurg 8(2):204–213CrossRefGoogle Scholar
  29. Scarff JE (1952) Nonobstructive hydrocephalus: treatment by endoscopic cauterization of the choroid plexus: long term results. J Neurosurg 9(2):164–176CrossRefGoogle Scholar
  30. Stone S, 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 14:439–446CrossRefGoogle Scholar
  31. Stookey B, Scarff JE (1936) Occlusions of the aqueduct of Sylvius by neoplastic and non- neoplastic processes with a rational surgical treatment for relief of the resultant obstructive hydrocephalus. Bull Neurol Inst NY 5:348–377Google Scholar
  32. Vries JK (1978) An endoscopic technique for third ventriculostomy. Surg Neurol 9(3):165–168PubMedGoogle Scholar
  33. 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):33–40CrossRefGoogle Scholar
  34. Warf BC (2005a) Hydrocephalus in Uganda: predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg 102(suppl 1):1–15PubMedGoogle Scholar
  35. Warf BC (2005b) 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 (6 Suppl Pediatrics) 103:475–481CrossRefGoogle Scholar
  36. Warf BC (2007) Endoscopic third ventriculostomy combined with choroid plexus cauterization for pediatric hydrocephalus. Clin Neurosurg 54:78–82PubMedGoogle Scholar
  37. Warf BC (2013) 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(6):935–940CrossRefGoogle Scholar
  38. Warf BC (2014) Three steps forward and two steps back: The Echternach Procession toward optimal hydrocephalus treatment. Neurosurgery 61:105–110CrossRefGoogle Scholar
  39. Warf BC (2015) Combined endoscopic third Ventriculostomy and choroid plexus cauterization (ETV/CPC) for hydrocephalus in infants and children with special emphasis on the developing world, 2nd edn. Endo-Press, TuttlingenGoogle Scholar
  40. Warf BC, Campbell JW (2008) Combined endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC) as primary treatment of hydrocephalus for infants with myelomeningocele: long-term results of a prospective intention to treat study in 115 African infants. J Neurosurg Pediatr 2:310–316CrossRefGoogle Scholar
  41. Warf BC, Kulkarni A (2010) Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children. J Neurosurg Pediatr 5:204–209CrossRefGoogle Scholar
  42. Warf BC, Ondoma S, Kulkarni A, Donnelly R, Ampeire M, Akona J, Kabachelor C, Mulondo R, Nsubuga B (2009) Neurocognitive outcome and ventricular volume in myelomeningocele children treated for hydrocephalus in Uganda. J Neurosurg Pediatr 4:564–570CrossRefGoogle Scholar
  43. Warf BC, Mugamba J, Kulkarni A (2010) Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. J Neurosurg Pediatr 5:143–148CrossRefGoogle Scholar
  44. Warf BC, Alkire BC, Bhai S, Hughes C, Schiff S, Vincent J, Meara JGT (2011a) Costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa. J Neurosurg Pediatr 8:509–521CrossRefGoogle Scholar
  45. Warf BC, Stagno V, Mugamba J (2011b) Encephalocele in Uganda: ethnic variation in lesion location, endoscopic management of hydrocephalus, and survival in 110 consecutive children. J Neurosurg Pediatr 7:88–93CrossRefGoogle Scholar
  46. Warf BC, Dewan M, Mugamba J (2011c) Management of Dandy-Walker Complex-associated infant hydrocephalus by combined endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC). J Neurosurg Pediatr 8:377–383CrossRefGoogle Scholar
  47. Warf BC, Dagi AR, Nsbuga B, Schiff SJ (2011d) Five-year survival and outcome of treatment for post-infectious hydrocephalus in Ugandan infants. J Neurosurg Pediatr 8:502–508CrossRefGoogle Scholar
  48. Warf BC, Campbell JW, Riddle E (2011e) Initial experience with combined endoscopic third ventriculostomy and choroid plexus cauterization for post-hemorrhagic hydrocephalus of prematurity: the importance of pre-pontine cistern status and the predictive value of FIESTA MRI imaging. Childs Nerv Syst 27:1063–1071CrossRefGoogle Scholar
  49. Warf BC, Tracy S, Mugamba J (2012a) Long term outcome for combined endoscopic third ventriculostomy and choroid plexus cauterization (ETV-CPC) compared to ETV alone for congenital aqueductal stenosis in African infants. J Neurosurg Pediatr 10:108–111CrossRefGoogle Scholar
  50. Warf BC, Bhai S, Kulkarni AV, Mugamba J (2012b) Shunt survival after failed endoscopic treatment for hydrocephalus. J Neurosurg Pediatr 10:463–470CrossRefGoogle Scholar
  51. Weil AG, Fallah A, Chamiraju P, Ragheb J, Bhatia S (2015) Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus. J Neurosurg Pediatr 30:1–11Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryChildren’s Hospital Boston, Harvard Medical SchoolBostonUSA

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