Volume 3, Issue 2, December 2019, Page: 32-37
Outcome of Choroid Plexus Cauterization with Endoscopic 3rd Ventriculostomy vs Ventricular Shunting in Management of Hydrocephalus Secondary to Neural Tube Defect
Ahmed Zahe, Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mahmoud Saad, Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Abdelghany Elshamy, Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Received: Nov. 20, 2019;       Accepted: Dec. 3, 2019;       Published: Dec. 10, 2019
DOI: 10.11648/j.ijn.20190302.14      View  584      Downloads  91
Background: Different surgical management of infants suffering neural tube defects (NTD) associated hydrocephalus were reported in the literature. Great debate whether combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) is more effective than ventriculoperitoneal (VP) shuntfor management of congenital hydrocephalus secondary to neural tube defects ininfants younger than 1 year of age. Purpose: To evaluate and compare the therapeutic efficacy of ETV combined with CPC versus VP shunts in infants with infantile hydrocephalus associated with NTD. Methods: Thirty infants with infantile NTD associated hydrocephalus (de novo), were equally divided and randomly allocated to each intervention group either ETV/CPC or VP shunts). They were monitored for at least 6 months for any sign of raised intracranial pressure (rICP) and/or hydrocephalic metrics (fontanelle quality, HC, and ventricular size) were also documented and compared between two groups. Statistical Analysis: The association between intervention group and outcome was tested with Chi-square test and P=0.05 or less was considered statistically significant. Results: Of the total thirty patients included in the study, thirteen patients (43.3%) were male and seventeen were female (56.7%) with mean age of 80.3±11.5 days. Twenty patients (66%) were under 6 months of age. The overall success rate in 1-year follow-up was 54% and 60% for VP shunt and ETV/CPC, respectively; with the difference being not statistically significant. Conclusion: Combined ETV-CPC is considered a successful surgical option for treatment of infantile hydrocephalus associated with NTD; achieving success rate better than VPS implantation.
Endoscopic Third Ventriculostomy, Choroid Plexus Cauterization, Neural Tube Defect, Hydrocephalus
To cite this article
Ahmed Zahe, Mahmoud Saad, Abdelghany Elshamy, Outcome of Choroid Plexus Cauterization with Endoscopic 3rd Ventriculostomy vs Ventricular Shunting in Management of Hydrocephalus Secondary to Neural Tube Defect, International Journal of Neurosurgery. Vol. 3, No. 2, 2019, pp. 32-37. doi: 10.11648/j.ijn.20190302.14
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
D. J. McCarthy, D. L. Sheinberg, E. Luther et al. "Myelo-meningocele associated hydrocephalus: nationwide analysis and systematic review". Neurosurg Focus 47 (4): E5, 2019.
M. Arslan, M. Eseoglu, B. O. Gudu et al."Comparison of simultaneous shunting to delayed shunting in infants with myelomeningocele in terms of shunt infection rate". Turk Neurosurg 21:397–402, 2011.
A, Chakraborty, D. Crimmins, R. Hayward et al. "Toward reducing shunt placement rates in patients with myelomeningocele". J Neurosurg Pediatr 1: 361–365, 2008.
P. A Beuriat, A. Szathmari, B. Grassiot et al. "Role of endoscopic third ventriculostomy in the management of myelomeningocele-related hydrocephalus: a retrospective study in a single French institution". World Neurosurg 87: 484–493, 2016.
B. C. Warf and J. W. Campbell."Combined endoscopic third ventriculostomyand choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelo-meningocele: long-term results of a prospective intent-to-treat study in 115 East African infants". J Neurosurg Pediatr 2: 310–316, 2008.
E. A. Elgamal."Natural history of hydrocephalus in children with spinal open neural tube defect". Surg Neurol Int 3: 112, 2012.
F. Radmanesh, F. Nejat, M. El-Khashab et al. "Shunt complications in children with myelomeningocele: effect of timing of shunt placement". Clinical article. J Neurosurg Pediatr 3:516–520, 2009.
M. C. Dewan and R. P. Naftel." The global rise of endoscopic third ventriculostomy with choroid plexus cauterization in pediatric hydrocephalus". Pediatr Neurosurg 52: 401–408, 2017.
R. F. Jones, B. C. Kwok, W. A. Stening et al." Third ventriculostomy for hydrocephalus associated with spinal dysraphism: indications and contraindications". Eur J Pediatr Surg 6 (Suppl 1): 5–6, 1996.
S. Perez da Rosa, C. P. Millward, V. Chiappa et al. "Endoscopic third ventriculostomy in children with myelomeningocele: a case series". Pediatr Neurosurg 50: 113–118, 2015.
A. V. Kulkarni, S. Sgouros, S. Constantini S. "International Infant Hydrocephalus Study: Initial results of a prospective, multicenter comparison of endoscopic third ventriculostomy (ETV) and shunt for infant hydrocephalus". Childs Nerv Syst 32: 1039–48, 2016.
A. Mohanty, M. K. Vasudev, S. Sampath, S. Radhesh, A. Mohanty et al. “Failed endoscopic third ventriculostomy in children: Management Options”. Pediatr Neurosurg 37: 304-309, 2002.
I. S. Oktem, A. Menkü, A. Ozdemir." When should ventriculo-peritoneal shunt placement be performed in cases with myelomeningocele and hydrocephalus?" Turk Neurosurg 18: 387–391, 2008.
F. C. Margaron, D. Poenaru, R. Bransford et al. "Timing of ventriculoperitoneal shunt insertion following spina bifida closure in Kenya". Childs Nerv Syst 26: 1523–1528, 2010.
G. Tamburrini, P. Frassanito, K. Iakovaki et al." Myelomeningocele: the management of the associated hydrocephalus". Childs Nerv Syst 29: 1569–1579, 2013.
M. Caldarelli, C. Di Rocco, F. La Marca."Shunt complications in the first postoperative year in children with meningo-myelocele". Childs Nerv Syst 12:748–754, 1996.
S. Tuli, J. Drake, M. Lamberti-Pasculli."Long-term outcome of hydrocephalus management in myelomeningoceles". Childs Nerv Syst 19: 286–291, 2003.
P. D. Miller, I. F. Pollack, D. Pang et al."Comparison of simultaneous versus delayed ventriculoperitoneal shunt insertion in children undergoing myelomeningocele repair". J Child Neurol 11: 370–372, 1996.
G. Kahilogullari, V. Etus, T. M. Guler et al."Does shunt selection affect the rate of early shunt complications in neonatal myelomeningocele-associated hydrocephalus? A multi-center study". Turk Neurosurg 28: 303–306, 2018.
J. M. Drake and Canadian Pediatric Neurosurgery Study Group. "Endoscopic third ventriculostomy in pediatric patients: The Canadian experience". Neurosurgery 60: 881-6, 2007.
S. E. Natelson. "Early third ventriculostomy in meningo-myelocele infants-shunt independence?" Childs Brain 8: 321–325, 1981.
C. Teo and R. Jones. "Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele”. PediatrNeurosurg 25: 57–63, 1996.
J. Rei, J. Pereira, C. Reis et al. "Endoscopic third ventriculostomy for the treatment of hydrocephalus in a pediatric population with myelomeningocele". World Neurosurg 105: 163–169, 2017.
G. S. Liptak, B. S. Masiulis, J. V. McDonald."Ventricular shunt survival in children with neural tube defects". Acta Neurochir 74: 113–117, 1985.
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