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Olufemi B. Bankole, Omotayo A. Ojo, Mathias N. Nnadi, Okezie O. Kanu and John O. Olatosi

environment. 6 , 15 , 25 Endoscopic third ventriculostomy (ETV) has become increasingly recognized as a viable treatment for hydrocephalus in children. 21 , 26 , 27 It promises a simpler complication profile and lower risk of infection. Traditionally, ETV was reserved for children older than 2 years; more recently, however, its use in infants, especially when combined with choroid plexus cauterization (CPC), results in successful outcomes in many cases previously thought unsuitable for treatment by endoscopic means. 23 , 26 , 27 At present, the scope of patients who can

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Michael C. Dewan, Jaims Lim, Clinton D. Morgan, Stephen R. Gannon, Chevis N. Shannon, John C. Wellons III and Robert P. Naftel

E ndoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) for the treatment of infantile hydrocephalus is being performed as an alternative to shunting. 7 , 11 , 12 , 16 Multiple validated success scales exist as simple tools to calculate the expected success rate of endoscopically treated hydrocephalus based on preoperative variables. 6 , 15 All of these predictive models depend on the manner in which the diagnosis of failure is established. The decision making in diagnosing ETV/CPC success or failure remains subjective, ambiguous

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Parthasarathi Chamiraju, Sanjiv Bhatia, David I. Sandberg and John Ragheb

survival in a newly inserted ventricular shunt . J Neurosurg 107 : 6 Suppl 448 – 454 , 2007 21 Volpe JJ : Neurology of the Newborn ed 5 Philadelphia , Saunders Elsevier , 2008 22 Warf BC : Comparison of 1-year outcomes for the Chhabra and Codman-Hakim Micro Precision shunt systems in Uganda: a prospective study in 195 children . J Neurosurg 102 : 4 Suppl 358 – 362 , 2005 23 Warf BC : Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in

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Yosef Ellenbogen, Karanbir Brar, Kaiyun Yang, Yung Lee and Olufemi Ajani

’ follow-up. 9 , 10 As a result of the relatively high failure rate of ETV, the addition of choroid plexus cauterization (CPC) has been proposed to improve success rates. The rationale behind this approach has traditionally been based on the belief that the choroid plexus produces a large amount of CSF; therefore, by eliminating this source of CSF, the surgeon is likely reducing the amount of CSF required to be reabsorbed by the arachnoid villi, as well as the force applied to the ventricles. 11 , 12 Both of these processes should therefore ideally help to restore CSF

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Scellig S. D. Stone and Benjamin C. Warf

I n 2005, Warf first reported the technique and results of combining endoscopic third ventriculostomy (ETV) with bilateral endoscopic lateral ventricle choroid plexus cauterization (CPC) to treat hydrocephalus in infants. 13 Subsequently, the efficacy of the procedure has been demonstrated among distinct etiologies of hydrocephalus in infants, with overall long-term success of more than 60% for all patients if the prepontine cistern is not obstructed by arachnoid scarring. 14 , 16–19 , 22 , 23 With the exception of 2 studies from US institutions of ETV

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Andrew T. Hale, Amanda N. Stanton, Shilin Zhao, Faizal Haji, Stephen R. Gannon, Anastasia Arynchyna, John C. Wellons, Brandon G. Rocque and Robert P. Naftel

E ndoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has rapidly increased in use since its inception. 4 , 24 Many studies have investigated the effectiveness of ETV/CPC versus ventriculoperitoneal shunt (VP) placement, 13 , 14 , 25 including differentiating clinical and radiographic features defining ETV/CPC from VP shunt success. 2 While both procedures are effective in reducing intracranial pressure by diverting CSF, ETV/CPC success promises shunt independence and may be associated with decreased overall healthcare costs. 15

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Benjamin C. Warf, Michael Dewan and John Mugamba

combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children . J Neurosurg 103 : 6 Suppl 475 – 481 , 2005 36 Warf BC : Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy . J Neurosurg 102 : 1 Suppl 1 – 15 , 2005 37 Warf BC , Campbell JW : Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocele: long-term results of a

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Jonathan Pindrik, Jay Riva-Cambrin, Abhaya V. Kulkarni, Jessica S. Alvey, Ron W. Reeder, Ian F. Pollack, John C. Wellons III, Eric M. Jackson, Curtis J. Rozzelle, William E. Whitehead, David D. Limbrick Jr., Robert P. Naftel, Chevis Shannon, Patrick J. McDonald, Mandeep S. Tamber, Todd C. Hankinson, Jason S. Hauptman, Tamara D. Simon, Mark D. Krieger, Richard Holubkov, John R. W. Kestle and for the Hydrocephalus Clinical Research Network

C linical controversy remains regarding the optimal treatment strategy for permanent CSF diversion in new-onset hydrocephalus. Prior studies evaluating shunt insertion, endoscopic third ventriculostomy (ETV), and/or ETV with choroid plexus cauterization (CPC) have focused on standard outcome measures. Perioperative mortality rates have remained low among patients undergoing ETV with CPC (0%–2%) or CSF shunt insertion (0%). 1–6 While both types of procedures are associated with low rates of neurological morbidity, neuroendoscopic approaches have exhibited lower

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Aria Fallah, Alexander G. Weil, Kyle Juraschka, George M. Ibrahim, Anthony C. Wang, Louis Crevier, Chi-hong Tseng, Abhaya V. Kulkarni, John Ragheb and Sanjiv Bhatia

A fter Walter Dandy first attempted choroid plexus cauterization (CPC) in 1918, several authors attempted CPC as a standalone treatment of infantile hydrocephalus with moderate success throughout the 20th century. 6 , 12–15 Over the last decade, CPC has been reintroduced as an adjunct to endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus, particularly in sub-Saharan Africa, with the goal of improving shunt independence rates in children with risk factors for ETV failure, particularly infants or other patients with hydrocephalus

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Michael C. Dewan, Jaims Lim, Stephen R. Gannon, David Heaner, Matthew C. Davis, Brandy Vaughn, Joshua J. Chern, Brandon G. Rocque, Paul Klimo Jr., John C. Wellons III and Robert P. Naftel

T he role of endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) in the management of infantile hydrocephalus continues to rapidly evolve as data worldwide accrue and are made available to the neurosurgical community. 3 Throughout, the efficacy of ETV/CPC is necessarily tied to and compared with the treatment standard of ventricular shunting. 13 , 15 , 19 Naturally, the goal of both procedures is to optimize neurological development by reducing intracranial pressure by means of diverting CSF from the intraventricular space, and, in the