Introduction: CURE Hospital Uganda is a high volume hydrocephalus and spina bifida referral center for sub-Saharan Africa, performing hundreds of endoscopic choroid plexus cauterizations annually. In Uganda, Warf and colleagues have published endoscopic treatment outcomes with notable success in choroid plexus coagulation (CPC) for the myelomeningocele (MM) population. Highlighted in their prospective series of 115 MM patients, the addition of CPC to standard endoscopic third ventriculostomy (ETV) improved hydrocephalus treatment success from 34% with ETV to 76% for ETV plus CPC. The authors have noted enlarged volumes of the choroid plexus tela choroidea complex in MM patients and aim to compare the surgical volume of plexus in MM versus nonpostinfectious hydrocephalus (NPIH) patients.

Methods: In this study, 16 consecutive pediatric hydrocephalus patients were assigned to 2 groups: MM and NPIH. Prospective timing of bilateral CPC of the lateral ventricles and temporal horns for respective groups was recorded and surgical volumes compared. Data was collected from cases operated on by two surgeons.

Results: Both surgeons demonstrated longer surgical coagulation times, 15% (p=0.98) and 32% (p=0.98) higher in MM patients compared to NPIH patients.

Conclusions: With redundant tela choroidea and free floating robust choroid plexus in MM patients, surgical coagulation demands skillful technique and longer operative times. Preliminary data shows clinical significance. In the future, achieving a larger sample size may determine timing of CPC to be statistically significant. CURE hospital has noted historical success of ETV with the addition of CPC, specifically in the MM population. Etiology and implications of hypertrophied choroid as it relates to hydrocephalus calls for further evaluation and study.

Patient Care: ETV plus CPC has been reported to improve hydrocephalus treatment success. Knowing operative timing is important as it may affect patient outcome.

Learning Objectives: 1) Describe the importance of choroid plexus coagulation (CPC) with EVT for myelomengocele patients. 2) Discuss the differences in surgical coagulation times between myelomeningocele patients and nonpostinfectious hydrocephalus patients. 3)Identify a an effective method of improving hydrocephalus treatment and outcome.

References: 1. Warf BC. Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. Journal of neurosurgery. Dec 2005;103(6 Suppl):475-481. 2. Warf BC. The impact of combined endoscopic third ventriculostomy and choroid plexus cauterization on the management of pediatric hydrocephalus in developing countries. World neurosurgery. Feb 2013;79(2 Suppl):S23 e13-25. 3. Warf BC, Campbell JW. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocele: long-term results of a prospective intent-to-treat study in 115 East African infants. Journal of neurosurgery. Pediatrics. Nov 2008;2(5):310-316.