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Endoscopic third ventriculostomy and choroid plexus cauterization in infants with hydrocephalus: a retrospective Hydrocephalus Clinical Research Network study.
[hydrocephalus with stenosis of the aqueduct of sylvius]
The
use
of
endoscopic
third
ventriculostomy
(
ETV
)
with
choroid
plexus
cauterization
(
CPC
)
has
been
advocated
as
an
alternative
to
CSF
shunting
in
infants
with
hydrocephalus
.
There
are
limited
reports
of
this
procedure
in
the
North
American
population
,
however
.
The
authors
provide
a
retrospective
review
of
the
experience
with
combined
ETV
+
CPC
within
the
North
American
Hydrocephalus
Clinical
Research
Network
(
HCRN
)
.
All
children
(
<
2
years
old
)
who
underwent
an
ETV
+
CPC
at
one
of
7
HCRN
centers
before
November
2012
were
included
.
Data
were
collected
retrospectively
through
review
of
hospital
records
and
the
HCRN
registry
.
Comparisons
were
made
to
a
contemporaneous
cohort
of
758
children
who
received
their
first
shunt
at
<
2
years
of
age
within
the
HCRN
.
Thirty
-
six
patients
with
ETV
+
CPC
were
included
(
13
with
previous
shunt
)
.
The
etiologies
of
hydrocephalus
were
as
follows
:
intraventricular
hemorrhage
of
prematurity
(
9
patients
)
,
aqueductal
stenosis
(
8
)
,
myelomeningocele
(
4
)
,
and
other
(
15
)
.
There
were
no
major
intraoperative
or
early
postoperative
complications
.
There
were
2
postoperative
CSF
infections
.
There
were
2
deaths
unrelated
to
hydrocephalus
and
1
death
from
seizure
.
In
18
patients
ETV
+
CPC
failed
at
a
median
time
of
30
days
after
surgery
(
range
4
-
484
days
)
.
The
actuarial
3
-
,
6
-
,
and
12
-
month
success
for
ETV
+
CPC
was
58
%
,
52
%
,
and
52
%
.
Time
to
treatment
failure
was
slightly
worse
for
the
36
patients
with
ETV
+
CPC
compared
with
the
758
infants
treated
with
shunts
(
p
=
0
.
012
)
.
Near-
complete
CPC
(
≥
90
%
)
was
achieved
in
11
cases
(
31
%
)
overall
,
but
in
50
%
(
10
of
20
cases
)
in
2012
versus
6
%
(
1
of
16
cases
)
before
2012
(
p
=
0
.
009
)
.
Failure
was
higher
in
children
with
<
90
%
CPC
(
HR
4
.
39
,
95
%
CI
0
.
999
-
19
.
2
,
p
=
0
.
0501
)
.
The
early
North
American
multicenter
experience
with
ETV
+
CPC
in
infants
demonstrates
that
the
procedure
has
reasonable
safety
in
selected
cases
.
The
degree
of
CPC
achieved
might
be
associated
with
a
surgeon
's
learning
curve
and
appears
to
affect
success
,
suggesting
that
surgeon
training
might
improve
results
.
Diseases
Validation
Diseases presenting
"first shunt"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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