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

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.