ETV+CPC Success and Evolving Indications over Time: A Prospective HCRN Study

HCRN investigator Dr. Jay Riva-Cambrin presented an overview of HCRN’s preliminary research on Endoscopic third ventriculostomy and choroid plexus coagulation (ETV+CPC), at a recent meeting of pediatric neurosurgeons. ETV+CPC is gaining in popularity as a treatment option for infants (age less than 2 years) with hydrocephalus. However, success rates vary; therefore we need to identify risk factors to guide neurosurgeons in properly selecting patients who will most benefit from this new procedure.

The HCRN examined children under two years who underwent ETV+CPC with data collected prospectively within the HCRN Core Data Project or Registry. We found 192 children. We examined patient characteristics, findings on their CT or MRI, and findings seen by the surgeons during the operation.

Overall, 45% of ETV+CPC were successful at 6 months. We found that only patient’s age at surgery and the etiology (or cause) of hydrocephalus predicted whether the ETV+CPC would be successful or not. Specifically, ETV+CPC was more successful if done at 6 months of age or older. Success was quite poor for those patients who had the procedure within the first month of life. ETV+CPC was most successful in those infants with myelomeningocele (a form of spina bifida) and aqueductal stenosis as causes for their hydrocephalus. The procedure was less frequently successful in those premature infants with intraventricular hemorrhages and those with congenital communicating hydrocephalus. No radiological or operative findings such as the size of the hole or the amount of CPC were found to predict success of the operation. Further study within the HCRN on ETV+CPC is already underway.