title: Bilateral occipital endoscopic choroid plexus cauterization for persistent hydrocephalus following frontal endoscopic third ventriculostomy and choroid plexus cauterization--the "bowling ball" technique.
abstract: Endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) as a primary treatment for hydrocephalus is gaining popularity in North America, particularly among the infant population. Unfortunately, despite considerable experience with ETV/CPC at several centers, treatment failures still exist. Early reports have suggested that greater than 90 % cauterization of the choroid plexus is associated with improved clinical outcomes. However, individual patient anatomy and smaller overall ventricular size can limit the amount of choroid plexus cauterization that is technically possible through a single frontal burr hole. Furthermore, the degree of cauterization achieved by surgeons using this technique is difficult to quantify objectively. In this report, we describe the case of an infant who failed initial ETV/CPC but then had successful resolution of hydrocephalus after additional choroid plexus cauterization performed through bilateral occipital burr holes. The child remains shunt-free over a year after treatment, suggesting that this three-pronged CPC approach (the "bowling ball" technique) may be successful in some young children with persistent hydrocephalus after ETV/CPC from a single frontal burr hole.
authors.affiliation: Department of Neurosurgery, Morgan Stanley Children's Hospital of New York, Columbia University, New York, NY, USA. hannahemilygoldstein@gmail.com.|The Neurological Institute, Columbia University Medical Center, 710 West 168th Street, 4th floor, New York, NY, 10032, USA. hannahemilygoldstein@gmail.com.
authors.forename: Hannah E
authors.identifier: http://orcid.org/0000-0001-5466-2913
authors.initials: HE
authors.lastname: Goldstein
authors.affiliation: Department of Neurosurgery, Morgan Stanley Children's Hospital of New York, Columbia University, New York, NY, USA.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Kennedy
authors.affiliation: Department of Neurosurgery, Morgan Stanley Children's Hospital of New York, Columbia University, New York, NY, USA.
authors.forename: Junia
authors.initials: J
authors.lastname: Santos
authors.affiliation: Department of Neurosurgery, Morgan Stanley Children's Hospital of New York, Columbia University, New York, NY, USA.
authors.forename: Richard C E
authors.initials: RC
authors.lastname: Anderson
authors.affiliation: Department of Neurosurgery, Morgan Stanley Children's Hospital of New York, Columbia University, New York, NY, USA.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Feldstein
mesh_terms: D000293:Adolescent; D002425:Cautery / Q000379:methods*; D002831:Choroid Plexus / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000601:surgery*; D014696:Ventriculostomy / Q000379:methods*
keywords: Choroid plexus cauterization; Endoscopic third ventriculostomy; Hydrocephalus