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.