ETV-CPC for the treatment of infants with hydrocephalus: Predicting Success

By: Dr. Jenna Koschnitzky, National Director of Research Programs

The Background

Last year, the Hydrocephalus Clinical Research Network (HCRN) published a study comparing success rates of Endoscopic Third Ventriculostomy with Choroid Plexus Coagulation (ETV-CPC) compared to ETV alone and to shunts in babies under two years old.

The main result of the study was that the ETV-CPC six-month success rate was 36%(to read more about that study click here).In contrast, the shunt six-month success rate was 76% in a similar (matched) group of babies. For the ETV-CPC group, babies who were older, with smaller ventricles, and who had more choroid plexus cauterized tended to have higher success rates. However, the study was not large enough to provide a lot of detail on which infants had the best chance of success.

New Study

To determine which babies under two years old have the best chance of success with ETV-CPC, the HCRN decided to conduct a larger study. This study was recently published in the Journal of Neurosurgery: Pediatrics. Lead author on the study was Dr. Jay Riva-Cambrin from the Alberta Children’s Hospital, University of Calgary, Alberta, Canada.

The Results

This study included 191 babies treated with ETV-CPC before two years (24 months) corrected age. For the group, the ETV-CPC success rate at six months after treatment was 48% and at one year was 46%.

However, a corrected age of < 1 month when the ETV-CPC procedure was performed as well as babies with posthemorrhagic hydrocephalus had lower success rates.

One year after treatment, the success rate for babies treated at < 1 month corrected age was 32%. This rate jumped to 60% for babies between 1-5 months corrected age and continued to improve in babies older than 5 months corrected age.

One year after treatment, the success rates for babies with posthemorrhagic hydrocephalus were 9%, 28%, 75%, and 0% when treated at corrected ages < 1 month, 1-5 months, 6-11 months, and ≥1 year, respectively. These rates can be compared to the rates for babies with myelomeningocele (48%, 62%, 100%, and 100%), aqueductal stenosis (32%, 60%, 83%, and 100%), and other types of hydrocephalus (mixed group) (49%, 46%, 49%, and 100%).

The Conclusions

Success rates for ETV-CPC were different depending on the age when the baby was treated and the type of hydrocephalus. Babies with myelomeningocele or other non-posthemorrhagic types of hydrocephalus as well as babies with aqueductal stenosis (> 1 month corrected age) may be the best candidates for ETV-CPC. Families and neurosurgeons should discuss these results when determining if a baby under two (2) years old should receive a shunt or undergo the ETV-CPC procedure.

For access to the original article please visit: https://www.ncbi.nlm.nih.gov/pubmed/31151098

For access to the 2018 ETV-CPC versus Shunt article, please visit: https://www.ncbi.nlm.nih.gov/pubmed/29243972.

The articles will also be accessible on the HCRN website: https://hcrn.org/research/publications/.