Efficacy of Combined Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization in Treatment of Hydrocephalus

Официальное название

Efficacy of Combined Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization as Primary Treatment for Paediatric Hydrocephalus

Обзор

Hydrocephalus remains one of the most common conditions encountered in neurosurgery, traditionally managed by ventriculoperitoneal (VP) shunting. Despite its effectiveness, shunt dependency is associated with certain complications including infection, obstruction, and repeated revisions, leading to increased morbidity and healthcare burden. Over the last 70 years, cerebrospinal fluid (CSF) shunting and more recently endoscopic third ventriculostomy (ETV) have been the mainstays of hydrocephalus treatment. In recent years, choroid plexus cauterization (CPC) has re-emerged as an additional treatment strategy. In combination with ETV, CPC increases the chances of successfully treating some cases with hydrocephalus, than ETV alone. Endoscopic Third Ventriculostomy (ETV) has emerged as an alternative physiological treatment by creating a bypass for cerebrospinal fluid (CSF) flow. However, its success is limited in infants and in other varieties of hydrocephalus. The addition of Choroid Plexus Cauterization (CPC), which reduces CSF production, has been shown to improve outcomes when combined with ETV, particularly in younger patients. The idea is based on the principle that ablation of the predominant source of CSF secretion within the brain, choroid plexus (CP), reduces CSF production. In addition, CPC may reduce CSF pulsatility, an effect which may be potentiated when combined with ETV, which might reduce intraventricular pulsations by serving as a pulsation absorber. These effects, in combination, may tip the balance in favour of CSF absorption and negate the need for shunting in a proportion of patients. The combined ETV-CPC approach, popularized by Benjamin Warf, has demonstrated promising results in reducing shunt dependence, especially in resource-limited settings. However, variability in success rates persists due to differences in patient selection, etiology, and surgical expertise. This study aims at evaluation of the efficacy of combined ETV-CPC as a primary treatment modality for hydrocephalus and to identify predictors of surgical success and failure, thereby optimizing patient selection and improving outcomes.

Вмешательства

• Процедура Combined endoscopic third ventriculostomy & coroid plexus cauterization
  Using ETV \& CPC in paediatric hydrocephalus will reduce Complications as CSF leak and Infection, Hospital stay, Evaluate time to failure, Compare outcomes across different hydrocephalus aetiologies and Medical care cost.

Первичные конечные точки

• 2. shunt-free survival [Срок оценки: 2 years minimumly]

Вторичные конечные точки (2)

• Change in health care burden of paediatric hydrocephalus [Срок оценки: 2 years minimumly]
• Change in rate of hospital admissions [Срок оценки: 2 years minimumly]

Критерии участия

Критерии включения

• Children below 18 years
• Radiologically diagnosed obstructive hydrocephalus
• Late onset aqueductal stenosis cases

Критерии исключения

• Communicating hydrocephalus.
• Acute interventricular haemorrhage cases
• Active infection cases
• Multilocular hydrocephalus cases
• Previous CSF diversion cases

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Египет · 1 центр

• Assuit University Hospital — Asyut

Идентификаторы

NCT: NCT07735936 · ETV & CPC in hydrocephalus

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗