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The problem
Endoscopic third ventriculostomy (ETV) —in which a small perforation is made in the third ventricle of the brain, allowing cerebrospinal fluid (CSF) to circulate—can often be a permanent treatment for hydrocephalus that avoids the complications of shunt dependence. But this procedure has been less successful in infants, most likely because it requires competent CSF circulation and absorption pathways that may not have had time to develop.
Innovative solution
A treatment pioneered by Children's Hospital Boston's Benjamin C. Warf, MD, combines ETV with choroid plexus cauterization (ETV/CPC), decreasing the amount of CSF produced and thereby reducing the demands the ETV places on the structure of the developing brain.
Results
Research has shown that ETV/CPC can obviate the need for a shunt in infants with hydrocephalus, in association with spina bifida or encephalocele more than 75 percent of the time, in association with neonatal infection more than 60 percent of the time and in association with other causes of congenital hydrocephalus around 70 percent of the time. Preliminary data in Dr. Warf's current investigation indicates that ETV/CPC could allow half of infants with post-hemorrhagic hydrocephalus of prematurity to forego shunt dependence.
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