Comparison of ETV/CPC versus ETV alone versus VP shunt alone in infants

Journal of Neurosurgery, Pediatrics

This study from the Hydrocephalus Clinical Research Network is the first prospective, multi-institution comparison of endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) to ventriculoperitoneal shunting (VPS) in North America. 118 infants under 2 years old (adjusted age for those born prematurely) who underwent ETV/CPC were compared to a matched cohort who were treated with VPS and a second matched cohort treated with ETV alone. Cases were matched on age and hydrocephalus etiology. All data were collected prospectively and analyzed retrospectively. Inclusion criteria, primary and secondary outcomes, and complications were rigorously defined before data analysis.

Kaplan Meier survival curves and Cox regression models were constructed. Considering only the infants treated with ETV/CPC, higher success was independently associated with older age, smaller baseline ventricles (shown by frontal-occipital horn ratio), and greater extent of CPC. When compared with 112 matched VPS cases, ETV/CPC had a significantly higher failure rate (p<0.001). The ETV/CPC failure rate was similar in comparison to the ETV alone cohort, but this analysis was limited since the ETV alone group was almost entirely children with aqueductal stenosis.  The authors posit that less failure with increasing extent of CPC suggests that some patient subgroups may benefit from adding CPC, and further investigation is needed to define these subgroups.

Brandon G. Rocque, MD, MS
Birmingham, AL