Choroid plexus coagulation in infants with extreme hydrocephalus or hydranencephaly.
OBJECT.: Severe hydrocephalus and hydranencephaly are common congenital conditions in Kenya. In patients with these conditions, ventriculoperitoneal (VP) shunts are associated with appreciable complications and endoscopic third ventriculostomies (ETVs) have limited success. Endoscopic choroid plexus coagulation (CPC) to diminish CSF production is a potential treatment option. The purpose of this study was to evaluate the effect of CPC without ETV in infants with severe hydrocephalus or hydranencephaly.


METHODS
Medical records of infants with severe congenital hydrocephalus or hydranencephaly who underwent CPC in Kijabe Hospital from November 2010 to April 2013 were reviewed retrospectively. Thirty-three patients with complete medical records and preoperative radiographic images were identified. After CPC, the infants were followed in the Kijabe Hospital outpatient department, in mobile clinics, or by telephone. Success of the CPC was defined as resolution of preoperative symptoms, stabilization of head size, and avoidance of VP shunt placement.


RESULTS
Patients were followed from 30 to 608 days (median of 120 days). Three patients were lost to follow-up. Of the 30 evaluable patients, CPC was considered to be successful in 13 (43.3%), including 8 of 20 patients with severe hydrocephalus and 5 of 10 with hydranencephaly. Failure of CPC was evident from increased head circumference in 14 (82%) of 17 patients and from CSF leakage in 3. Of the 17 failures, 13 occurred within 3 months of surgery. Six patients died: 3 whose CPC procedures were failures, 2 whose CPC was successful, and 1 postoperatively. Of the 17 in whom CPC failed, 10 subsequently underwent VP shunt insertion.


CONCLUSIONS
CPC stabilizes macrocephaly in approximately 40% of infants with severe congenital hydrocephalus and hydranencephaly and can be considered as an alternative to VP shunt placement.
Division of Neurosurgery, Department of Surgery, Kijabe Hospital, Kijabe, Kenya.
Sylvia
S
Shitsama
Nunthasiri
N
Wittayanakorn
Humphrey
H
Okechi
A Leland
AL
Albright
D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology*; D002675:Child, Preschool; D002831:Choroid Plexus / Q000601:surgery*; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D006832:Hydranencephaly / Q000601:surgery*; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007630:Kenya; D008297:Male; D044583:Neuroendoscopy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020542:Third Ventricle / Q000601:surgery; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D014696:Ventriculostomy / Q000009:adverse effects* / Q000379:methods
CPC = choroid plexus coagulation; ETV = endoscopic third ventriculostomy; VP = ventriculoperitoneal; choroid plexus coagulation; hydranencephaly; hydrocephalus