Hydrocephalus | ETV/CPC Procedure

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Benjamin Warf, MD, Boston Children's Hospital neurosurgeon and director of Neonatal and Congenital Anomaly Neurosurgery, pioneered a treatment for hydrocephalus in infants that combines two procedures: endoscopic third ventriculostomy (ETV) and choroid plexus cauterization procedure (CPC). Combined, this procedure is called ETV/CPC.

ETV is a minimally-invasive procedure that creates an opening in the floor of the third ventricle in the brain, allowing trapped fluid to escape into its normal pathway. CPC is a procedure to close off areas in the brain (called choroid plexus) that produce cerebrospinal fluid.

Historically, neurosurgeons had treated some cases of hydrocephalus with CPC, but the technique had largely been abandoned until Warf began combining it with ETV and found this combined procedure was superior to ETV alone in infants.

During the ETV/CPC procedure, the neurosurgeon:

  • makes a small incision in the scalp
  • removes a tiny window of bone in the skull
  • inserts a miniature tube (called an endoscope) that can conduct precise electrical charges (the endoscope has a lens at one end and is attached to a video camera so the surgeon can see)
  • advances the endoscope into the fluid spaces inside the brain (the ventricles)
  • performs the ETV by making an opening in the floor of the third ventricle
  • identifies the choroid plexus in the first and second ventricles
  • turns on the electrical charge once the tube is in position, cauterizing the choroid plexus in these two ventricles (but preserving the choroid plexus in the third and fourth ventricles, allowing continued production of cerebrospinal fluid)

The dual strength of this approach reduces the production of cerebrospinal fluid in the first and second ventricles, while also eliminating blockages between the third and fourth ventricles.

Warf has published a study that reveals the combined ETV/CPC procedure is more effective in treating infants younger than 1 year than ETV alone. ETV/CPC has also proven to be a successful treatment for most infants with both hydrocephalus and spina bifida.

Warf is training pediatric neurosurgeons in ETV/CPC in Africa and other areas of the world, with a goal of drastically reducing dependence on shunts in the developing world. Learn more about his work.

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