Endoscopic Treatment versus Shunting for Infant Hydrocephalus

PE
Source: 
NEJM

Endoscopic treatment of hydrocephalus in developing countries enables effective CSF diversion. Yet, several studies have demonstrated relative ventriculomegaly despite successful CSF shunting in patients undergoing endoscopic third ventriculostomy and choroid plexus cauterization (ETV-CPC) versus ventriculoperitoneal shunting (VPS). The secondary effects of differing CSF volumes between the approaches on cortical mantle development and neurodevelopmental outcomes is unknown.  The authors randomized infants < 6months of age with post-infectious hydrocephalus between VPS (n=47) and ETV-CPC (n=47). There was no significant difference in primary outcome measure Infant Development scores that encompass language, motor and cognitive development at 12-month follow up. Substantial brain growth was lower in the ETV-CPC group. Though shunted patients had significantly lower CSF volumes, the proportion of infants with normal brain volume was similar between groups. The study provides the first direct comparison of cognitive outcomes but will need to be validated long-term follow-up in larger cohorts with more diverse etiologies. 

Raheel Ahmed, MD
Madison, Wisconsin

Comments

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CHENNAI KELAMBAKKAM,
Both treatments apparently improve BULK CSF ABSORPTION. Micro-Physiologically, third ventriculostomy will cause the CSF to flow up along the surface of the brain to finally drain into SSS. Micro-anatomically the CSF will exit via the PIAL end arteries (ALTHOUGH ONLY MINOR ABSORPTIVE PATHWAY ).