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Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization (ETV–CPC) Versus CSF Shunting

  • William B. Lo
  • Abhaya V. Kulkarni
Chapter

Abstract

Choroid plexus removal and cautery was described a century ago, but went out of vogue due to its technical difficulty and associated morbidity. From the 1950s to 2000s, cerebrospinal fluid shunts and endoscopic third ventriculostomy (ETV) remained the mainstay of treatment for pediatric hydrocephalus, including infants. In the 2000s, Warf’s innovative development of the modern ETV with choroid plexus cauterization (CPC) technique and robust scientific study in the unique setting of the CURE Children’s Hospital of Uganda brought a renaissance of choroid plexus obliteration as a safe and effective treatment option. This chapter recounts the history of choroid plexus surgery, explains its biologic and pathophysiologic basis, describes the operative technique and outcome of ETV+CPC in the global setting, and compares it with other conventional treatments.

Keywords

Endoscopic third ventriculostomy Choroid plexus cauterization ETV–CPC CSF shunting Cerebrospinal fluid 

References

  1. 1.
    Kulkarni AV, Drake JM, Mallucci CL, Sgouros S, Roth J, Constantini S. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr. 2009;155(2):254–259.e1.  https://doi.org/10.1016/j.jpeds.2009.02.048.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kulkarni AV, Riva-Cambrin J, Browd SR, et al. Endoscopic third ventriculostomy and choroid plexus cauterization in infants with hydrocephalus: a retrospective hydrocephalus clinical research network study. J Neurosurg Pediatr. 2014;14(3):224–9.  https://doi.org/10.3171/2014.6.PEDS13492.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Warf BC. 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. 2005;103(6 Suppl):475–81.  https://doi.org/10.3171/ped.2005.103.6.0475.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kulkarni AV, Riva-Cambrin J, Butler J, et al. Outcomes of CSF shunting in children: comparison of hydrocephalus clinical research network cohort with historical controls: clinical article. J Neurosurg Pediatr. 2013;12(4):334–8.  https://doi.org/10.3171/2013.7.PEDS12637.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Drake JM, Kestle JRW, Miner R, et al. Randomized trial of CSF shunt valve design in pediatric hydrocephalus. Neurosurgery. 1998;43(August 1998):1–8.Google Scholar
  6. 6.
    Kestle JRW, Riva-Cambrin J, Wellons JC, et al. A standardized protocol to reduce cerebrospinal fluid shunt infection: the hydrocephalus clinical research network quality improvement initiative. J Neurosurg Pediatr. 2011;8(1):22–9.  https://doi.org/10.3171/2011.4.PEDS10551.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kulkarni AV, Drake JM, Rabin D, Dirks PB, Humphreys RP, Rutka JT. Measuring the health status of children with hydrocephalus by using a new outcome measure. J Neurosurg. 2004;101(2 Suppl):141–6.  https://doi.org/10.3171/ped.2004.101.2.0141.CrossRefPubMedGoogle Scholar
  8. 8.
    Hunt GM, Oakeshott P, Kerry S. Link between the CSF shunt and achievement in adults with spina bifida. J Neurol Neurosurg Psychiatry. 1999;67:591–5.  https://doi.org/10.1136/jnnp.68.6.800.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kulkarni AV, Shams I. Quality of life in children with hydrocephalus: results from the Hospital for Sick Children, Toronto. J Neurosurg. 2007;107(5 Suppl):358–64.  https://doi.org/10.3171/PED-07/11/358.CrossRefPubMedGoogle Scholar
  10. 10.
    Kulkarni AV, Cochrane DD, McNeely PD, Shams I. Medical, social, and economic factors associated with health-related quality of life in Canadian children with hydrocephalus. J Pediatr. 2008;153(5):689–95.  https://doi.org/10.1016/j.jpeds.2008.04.068.CrossRefPubMedGoogle Scholar
  11. 11.
    Simon TD, Riva-Cambrin J, Srivastava R, Bratton SL, Dean JM, Kestle JRW. Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatr. 2008;1(2):131–7.  https://doi.org/10.3171/PED/2008/1/2/131.CrossRefPubMedGoogle Scholar
  12. 12.
    Jones R, Stening W, Brydon M. Endoscopic third ventriculostomy. Neurosurgery. 1990;26(1):86–91.  https://doi.org/10.1227/00006123-199001000-00012.CrossRefPubMedGoogle Scholar
  13. 13.
    Drake JM. Endoscopic third Ventriculostomy in pediatric patients: the Canadian experience. Neurosurgery. 2007;60(5):881–6.  https://doi.org/10.1227/01.NEU.0000255420.78431.E7.CrossRefPubMedGoogle Scholar
  14. 14.
    Kulkarni AV, Drake JM, Kestle JR, Malluci CL, Sgouros S, Constantini S. Endoscopic third Ventriculostomy vs cerebrospinal fluid shunt in the treatment of hydrocephalus in children: a propensity score–adjusted analysis. Neurosurgery. 2010;67(3):588–93.  https://doi.org/10.1227/01.NEU.0000373199.79462.21.CrossRefPubMedGoogle Scholar
  15. 15.
    Kulkarni AV, Drake JM, Kestle JRW, Mallucci CL, Sgouros S, Constantini S. Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV success score. J Neurosurg Pediatr. 2010;6(4):310–5.  https://doi.org/10.3171/2010.8.PEDS103.CrossRefPubMedGoogle Scholar
  16. 16.
    Kahle KT, Kulkarni A, Limbrick DD, Warf BC. Hydrocephalus in children. Lancet. 2016;136:788–199.  https://doi.org/10.1016/B978-0-444-53486-6.00064-8.CrossRefGoogle Scholar
  17. 17.
    Jernigan SC, Berry JG, Graham DA, Goumnerova L. The comparative effectiveness of ventricular shunt placement versus endoscopic third ventriculostomy for initial treatment of hydrocephalus in infants. J Neurosurg Pediatr. 2014;13(3):295–300.  https://doi.org/10.3171/2013.11.PEDS13138.CrossRefPubMedGoogle Scholar
  18. 18.
    Dandy WE. Experimental hydrocephalus. Ann Surg. 1919;70(2):129–42.CrossRefGoogle Scholar
  19. 19.
    Bering EAJ. 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. 1962;19:405–13.CrossRefGoogle Scholar
  20. 20.
    Wilson CB, Bertan V. Interruption of the anterior choroidal artery in experimental hydrocephalus. Arch Neurol. 1967;17(6):614–9.  https://doi.org/10.1084/jem.19.1.106.CrossRefPubMedGoogle Scholar
  21. 21.
    Weiss MH, Nulsen FE, Kaufman B. Selective radionecrosis of the choroid plexus for control of experimental hydrocephalus. J Neurosurg. 1972;36(3):270–5.  https://doi.org/10.3171/jns.1972.36.3.0270.CrossRefPubMedGoogle Scholar
  22. 22.
    Milhorat TH. Choroid plexus and cerebrospinal fluid production. Science (80- ). 1969;166(3912):1514–6.CrossRefGoogle Scholar
  23. 23.
    Milhorat TH, Hammock MK, Fenstermacher JD, Rall DP, Levin VA. Cerebrospinal fluid production by the choroid plexus and brain. Science (80- ). 1971;173(3994):330–2.CrossRefGoogle Scholar
  24. 24.
    Warf BC. 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. 2013;29(6):935–40.  https://doi.org/10.1007/s00381-013-2072-1.CrossRefPubMedGoogle Scholar
  25. 25.
    Dandy WE. Extirpation of the choroid plexuses of the lateral ventricle in communicating hydrocephalus. Ann Surg. 1918;68(6):569–79.CrossRefGoogle Scholar
  26. 26.
    Dandy WE. The operative treatment of communicating hydrocephalus. Ann Surg. 1938;108:194–202.CrossRefGoogle Scholar
  27. 27.
    Dandy WE. An operative procedure for hydrocephalus. Bull Johns Hopkins Hosp. 1922;33:189–90.Google Scholar
  28. 28.
    Scarff JE. Endoscopic treatment of hydrocephalus. Description of a ventriculoscope and preliminary report of cases. JAMA. 1936;451:853–61.Google Scholar
  29. 29.
    Putnam TJ. Treatment of hydrocephalus by endoscopic coagulation of the choroid plexus. Description of a new instrument and preliminary report of results. NEJM. 1934;210:1373–6.CrossRefGoogle Scholar
  30. 30.
    Feld M. Ventriculoscope coagulant utilisé dans les hydrocephalies communicantes. Press médd. 1956;64:632.Google Scholar
  31. 31.
    Feld M. La coagulation des plexus choroides par ventriculoscopie directe dans l’hydrocephalie nonobstructive du nourrison. Neurochirurgie. 1957;3:70–9.PubMedGoogle Scholar
  32. 32.
    Scarff JE. Treatment of nonobstructive (communicating) hydrocephalus by cendoscopic cauterization of the choroid plexuses. Acta Psychiatr Scand. 1959;34(3):354–74.  https://doi.org/10.1111/j.1600-0447.1959.tb07585.x.CrossRefPubMedGoogle Scholar
  33. 33.
    Pople IK, Ettles D. The role of endoscopic choroid plexus coagulation in the management of hydrocephalus. Neurosurgery. 1995;36(4):698–701.  https://doi.org/10.1227/00006123-199504000-00009.CrossRefPubMedGoogle Scholar
  34. 34.
    Decq P, Le Guerinel C, Palfi S, Djindjian M, Kéravel Y, Nguyen J-P. A new device for endoscopic third ventriculostomy. J Neurosurg. 2000;93:509–12.CrossRefGoogle Scholar
  35. 35.
    Warf BC, Mugamba J, Kulkarni AV. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. J Neurosurg Pediatr. 2010;5(2):143–8.  https://doi.org/10.3171/2009.9.PEDS09196.CrossRefPubMedGoogle Scholar
  36. 36.
    Warf BC, Tracy S, Mugamba J. Long-term outcome for endoscopic third ventriculostomy alone or in combination with choroid plexus cauterization for congenital aqueductal stenosis in African infants. J Neurosurg Pediatr. 2012;10(2):108–11.  https://doi.org/10.3171/2012.4.PEDS1253.CrossRefPubMedGoogle Scholar
  37. 37.
    Warf BC. Hydrocephalus associated with neural tube defects: characteristics, management, and outcome in sub-Saharan Africa. Childs Nerv Syst. 2011;27(10):1589–94.  https://doi.org/10.1007/s00381-011-1484-z.CrossRefPubMedGoogle Scholar
  38. 38.
    Warf BC, Campbell JW. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocele: long-term results of a prospective intent-to-treat study in 115 east African infants. J Neurosurg Pediatr. 2008;2(5):310–6.  https://doi.org/10.3171/PED.2008.2.11.310.CrossRefPubMedGoogle Scholar
  39. 39.
    Steinbok P, Irvine B, Douglas Cochrane D, Irwin BJ. Long-term outcome and complications of children born with meningomyelocele. Childs Nerv Syst. 1992;8(2):92–6.  https://doi.org/10.1007/BF00298448.CrossRefPubMedGoogle Scholar
  40. 40.
    Warf BC, Dewan M, Mugamba J. Management of Dandy-Walker complex-associated infant hydrocephalus by combined endoscopic third ventriculostomy and choroid plexus cauterization. J Neurosurg Pediatr. 2011;8(4):377–83.  https://doi.org/10.3171/2011.7.PEDS1198.CrossRefPubMedGoogle Scholar
  41. 41.
    Kulkarni AV, Warf BC, Drake JM, Mallucci CL, Sgouros S, Constantini S. Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome. Childs Nerv Syst. 2010;26(12):1711–7.  https://doi.org/10.1007/s00381-010-1195-x.CrossRefPubMedGoogle Scholar
  42. 42.
    Warf BC. Comparison of 1-year outcomes for the Chhabra and Codman-hakim micro precision shunt systems in Uganda: a prospective study in 195 children. J Neurosurg Pediatr. 2005;102(4 Suppl):358–62.  https://doi.org/10.3171/ped.2005.102.4.0358.CrossRefGoogle Scholar
  43. 43.
    Warf B, Ondoma S, Kulkarni A, et al. Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda. J Neurosurg Pediatr. 2009;4(6):564–70.  https://doi.org/10.3171/2009.7.PEDS09136.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Warf BC, Bhai S, Kulkarni AV, Mugamba J. Shunt survival after failed endoscopic treatment of hydrocephalus. J Neurosurg Pediatr. 2012;10(6):463–70.  https://doi.org/10.3171/2012.9.PEDS1236.CrossRefPubMedGoogle Scholar
  45. 45.
    Warf BC, Dagi AR, Kaaya BN, Schiff SJ. Five-year survival and outcome of treatment for postinfectious hydrocephalus in Ugandan infants. J Neurosurg Pediatr. 2011;8:502–8.  https://doi.org/10.3171/2011.8.PEDS11221.CrossRefPubMedGoogle Scholar
  46. 46.
    National Institutes of Health. Neurocognitive outcomes and changes in brain and CSF volume after treatment of post-infectious hydrocephalus in Ugandan infants by shunting or ETV/CPC: a randomized prospective trial (5R21TW009612–02). Res Portf Online Report Tools. 2012. https://projectreporter.nih.gov/project_info_description.cfm?projectnumber=5R21TW009612-02. Accessed 15 Aug 2017.
  47. 47.
    National Institutes of Health. Neurocogntive outcomes and changes in brain and CSF volume after treatment of post-infectious hydrocephalus in Ugandan infants by shunting or ETV/CPC: a randomized prospective trial (1R01HD085853–01). Res Portf Online Report Tools. 2015. https://projectreporter.nih.gov/project_info_description.cfm?projectnumber=1R01HD085853-01. Accessed 15 Aug 2017.
  48. 48.
    National Institutes of Health. Randomized Controlled Trial of Shunt vs ETV/CPC for PIH in Ugandan Infants (NCT01936272). US Natl Libr Med. 2013. https://clinicaltrials.gov/ct2/show/NCT01936272. Accessed 15 Aug 2017.
  49. 49.
    Ogiwara H, Uematsu K, Morota N. Obliteration of the choroid plexus after endoscopic coagulation. J Neurosurg Pediatr. 2014;14(3):230–3.  https://doi.org/10.3171/2014.6.PEDS1438.CrossRefPubMedGoogle Scholar
  50. 50.
    Weil AG, Fallah A, Chamiraju P, Ragheb J, Bhatia S. Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus. J Neurosurg Pediatr. 2016;17:163–73.  https://doi.org/10.3171/2015.5.PEDS14692.CrossRefPubMedGoogle Scholar
  51. 51.
    Malheiros JA, Trivelato FP, Oliveira MM, Gusmão S, Cochrane DD, Steinbok P. Endoscopic choroid plexus cauterization versus ventriculoperitoneal shunt for hydranencephaly and near hydranencephaly: a prospective study. Neurosurgery. 2010;66:459.  https://doi.org/10.1227/01.NEU.0000365264.99133.CA.CrossRefPubMedGoogle Scholar
  52. 52.
    Zandian A, Haffner M, Johnson J, Rozzelle CJ, Tubbs RS, Loukas M. Endoscopic third ventriculostomy with/without choroid plexus cauterization for hydrocephalus due to hemorrhage, infection, Dandy-Walker malformation, and neural tube defect: a meta-analysis. Childs Nerv Syst. 2014;30(4):571–8.  https://doi.org/10.1007/s00381-013-2344-9.CrossRefPubMedGoogle Scholar
  53. 53.
    Stone SSD, Warf BC. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective north American series. J Neurosurg Pediatr. 2014;14(5):439–46.  https://doi.org/10.3171/2014.7.PEDS14152.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of NeurosurgeryHospital for Sick Children, University of TorontoTorontoCanada

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