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Objective <p>This study evaluates the efficacy and outcomes of endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) as a primary treatment for hydrocephalus associated with Chiari II malformation in infants.</p> Methods <p>This retrospective study analyzed 53 infants, all under 12&#xa0;months of age and post-myelomeningocele repair, who presented with hydrocephalus (Evans’ Index &gt; 0.3 or Frontal occipital horn ratio (FOHR) &gt; 0.4). All patients underwent Endoscopic third ventriculostomy (ETV) and bilateral choroid plexus cauterization (CPC) using a rigid endoscope. Success was defined as shunt-free survival with clinical and radiological improvement over a 12-month follow-up period.</p> Results <p>The cohort of 53 infants (28 males, 25 females) had a mean age of 3.4&#xa0;months, with 36% consanguinity. Patients were stratified into three age groups: &lt; 3&#xa0;months (<i>n</i> = 13), 3–6&#xa0;months (<i>n</i> = 19), and 6–12&#xa0;months (<i>n</i> = 21). The ETV + CPC success rate showed a positive correlation with age: 54% in the youngest group, 63% in the middle group, and 67% in the oldest group. Of the 20 failures, 14 required ventriculoperitoneal shunts (VPS), and 6 were managed with re-endoscopy for stoma closure. Meningitis was the most common complication (15%), with all affected patients eventually requiring a VP shunt.</p> Conclusion <p>ETV + CPC offers an effective, safe, and durable alternative to traditional VPS for infants with Chiari II-associated hydrocephalus. It significantly reduces shunt dependency and its associated long-term complications. Success rates improve with advancing age, making it a viable first-line surgical option in pediatric neurosurgery, particularly in resource-limited settings.</p>

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Role of choroid plexus cauterization in augmenting the success rate of endoscopic third ventriculostomy in Chiari II-associated hydrocephalus

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Mohamed Mohsen Amen,
  • Mohamed Badran,
  • Ahmed Zaher,
  • Mostafa Shahein

摘要

Objective

This study evaluates the efficacy and outcomes of endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) as a primary treatment for hydrocephalus associated with Chiari II malformation in infants.

Methods

This retrospective study analyzed 53 infants, all under 12 months of age and post-myelomeningocele repair, who presented with hydrocephalus (Evans’ Index > 0.3 or Frontal occipital horn ratio (FOHR) > 0.4). All patients underwent Endoscopic third ventriculostomy (ETV) and bilateral choroid plexus cauterization (CPC) using a rigid endoscope. Success was defined as shunt-free survival with clinical and radiological improvement over a 12-month follow-up period.

Results

The cohort of 53 infants (28 males, 25 females) had a mean age of 3.4 months, with 36% consanguinity. Patients were stratified into three age groups: < 3 months (n = 13), 3–6 months (n = 19), and 6–12 months (n = 21). The ETV + CPC success rate showed a positive correlation with age: 54% in the youngest group, 63% in the middle group, and 67% in the oldest group. Of the 20 failures, 14 required ventriculoperitoneal shunts (VPS), and 6 were managed with re-endoscopy for stoma closure. Meningitis was the most common complication (15%), with all affected patients eventually requiring a VP shunt.

Conclusion

ETV + CPC offers an effective, safe, and durable alternative to traditional VPS for infants with Chiari II-associated hydrocephalus. It significantly reduces shunt dependency and its associated long-term complications. Success rates improve with advancing age, making it a viable first-line surgical option in pediatric neurosurgery, particularly in resource-limited settings.