The Role of Endoscopic Choroid Plexus Coagulation in the Management of Hydrocephalus

Endoscopic choroid plexus coagulation has been used for the treatment of hydrocephalus at this unit for the past 20 years, and 156 operations have been performed on 116 patients. These patients were analyzed retrospectively to determine the rate of long-term clinical control of hydrocephalus, factors associated with successful control, change in ventricular size after surgery, and rate of surgical complicatioms. Data were found for 104 patients with a median age at surgery of 5 months (range, 1 wk-30 yr) and a mean follow-up of 10.5 years. Control of hydrocephalus by choroid plexus coagulation was found to be best in children with communicating hydrocephalus and a slow to moderate rate of increase in head circumference (18 of 28, 64% long-term control), whereas those who presented with tense fontanels and rapidly progressive hydrocephalus had the lowest rate of success. Overall, 36 of 104 (35%) achieved long-term control without cerebrospinal fluid shunts. The ventricular size was not significantly reduced by choroid plexus coagulation (ventricular index before and after surgery, 0.64 and 0.58, respectively; P=0.13), although sulcal markings became more prominent in all successfully treated patients, indicating reduced intracranial pressure. There were no deaths resulting from surgery, and serious morbidity was low. Eight patients developed infections (five meningitis and three implant infections). Other complications included postoperative fits (two patients), respiratory arrest in a premature infant (one patient), low-pressure state (one patient), ventricular drain displacement or blockage (eight patients), subdural effusion (one patient), and intraoperative minor ventricular bleeding, forcing abandonment of the procedure (two patients). The procedure was not associated with a greater risk of long-term epilepsy, and patients who subsequently required cerebrospinal fluid shunts suffered fewer mechanical blockages than would normally be expected. These results support the more widespread use of endoscopic choroid plexus coagulation as am alternative to a cerebrospinal fluid shunt in selected patients with milder communicating hydrocephalus and in patients with intractable shunt failure