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 operation s have been performed on 116 patients. These patients were analyzed re trospectively to determine the rate of long-term clinical control of h ydrocephalus, factors associated with successful control, change in ve ntricular size after surgery, and rate of surgical complications. 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 hyd rocephalus by choroid plexus coagulation was found to be best in child ren with communicating hydrocephalus and a slow to moderate rate of in crease in head circumference (18 of 28, 64% long-term control), wherea s those who presented with tense fontanels and rapidly progressive hyd rocephalus had the lowest rate of success. Overall, 36 of 104 (35%) ac hieved long-term control without cerebrospinal fluid shunts. The ventr icular size was not significantly reduced by choroid plexus coagulatio n (ventricular index before and after surgery, 0.64 and 0.58, respecti vely; P = 0.13), although sulcal markings became more prominent in all successfully treated patients, indicating reduced intracranial pressu re. There were no deaths resulting from surgery, and serious morbidity was low. Eight patients developed infections (five meningitis and thr ee implant infections). Other complications included postoperative fit s (two patients), respiratory arrest in a premature infant (one patien t), low-pressure state (one patient), ventricular drain displacement o r blockage (eight patients), subdural effusion (one patient), and intr aoperative minor ventricular bleeding, forcing abandonment of the proc edure (two patients). The procedure was not associated with a greater risk of long-term epilepsy, and patients who subsequently required cer ebrospinal fluid shunts suffered fewer mechanical blockages than would normally be expected. These results support the move widespread use o f endoscopic choroid plexus coagulation as an alternative to a cerebro spinal fluid shunt in selected patients with milder communicating hydr ocephalus and in patients with intractable shunt failure.