Hydrocephalus, literally “water on the brain,” is an abnormal build-up of cerebrospinal fluid in the brain cavities known as ventricles. In infants, it can be congenital (it often accompanies spina bifida, for example), or it can be caused by brain hemorrhage or infection. The usual treatment is surgery to implant a shunt, which drains the excess fluid into the abdomen, relieving pressure on the brain.
But over time, shunts nearly always fail, requiring emergency neurosurgery to repair or replace them. But emergency neurosurgery is not something that’s readily available outside of metropolitan areas. Untreated, hydrocephalus causes progressive brain damage and usually death.
What if a one-time operation could treat hydrocephalus permanently? In today’s New England Journal of Medicine, a randomized trial shows good results with a minimally invasive, relatively inexpensive shunt alternative called endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC).
Neurosurgeon Benjamin Warf, MD, of Boston Children’s Hospital pioneered ETV/CPC 17 years ago while serving as a medical missionary in Uganda, where shunt failures often are fatal. The operation has two parts. ETV uses an endoscope to create an opening in the floor of the third ventricle, allowing trapped cerebrospinal fluid to escape. CPC uses an electrical current to burn off some of the fluid-producing tissue. Warf explains hydrocephalus, shunting and ETV/CPC in this video:
ETV/CPC has been used to treat hydrocephalus caused by a variety of conditions. Though technically more difficult than shunt placement, failure rates after the six-month mark have been low.
“There are many advantages to avoiding lifelong dependence on a shunt,” says Warf, senior author of the NEJMstudy. “But one important unanswered question has been whether ETV/CPC is as good for infant brain development as placing a shunt.”
Read the full blog post: “One-time hydrocephalus operation, alternative to shunting, brings good outcomes for babies” on Vector Blog.
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