The role of Choroid plexus coagulation in management of hydrocephalus in pediatric patients /
Hala Emad Abd El Rahman Fahmy,
The role of Choroid plexus coagulation in management of hydrocephalus in pediatric patients / دور تجلط الضفيرة المشيمية بالكي في علاج استسقاء المخ لدى مرضى الأطفال / by Hala Emad Abd El Rahman Fahmy ; Under the supervision of Prof. Dr. Khaled Bassim Aly, Prof. Dr. Ehab Ahmed El Refaee, Dr. Mohamed Ahmed Ali Eissa Wahdan, Dr. Karim Abd El Aziz Mohamed. - 173 pages : illustrations ; 25 cm. + CD.
Thesis (M.Sc.)-Cairo University, 2023.
Bibliography: pages 158-173.
Hydrocephalus is a pathological condition characterized by the abnormal
accumulation of cerebrospinal fluid (CSF) within the ventricular system. The
accumulation of this fluid can occur due to either obstructed flow or impaired
absorption, with the most common causes being infection, intracranial
hemorrhage, or brain tumors. Recent hydrodynamic models propose that
hydrocephalus arises as a result of dysfunctional absorption of the CSF in the
subarachnoid and intraventricular spaces, leading to abnormally high amplitudes
of pulsation that can subsequently cause ventricular enlargement. The primary
treatment options for hydrocephalus are surgical in nature and include
ventriculoperitoneal shunt (VPS), endoscopic third ventriculostomy (ETV), and
endoscopic third ventriculostomy with choroid plexus cauterization (ETV-CPC)
(Pande et al.,2021)
Patients and Methods:
This study was conducted on 60 pediatric patients of both genders, who
presented with hydrocephalic changes due to diverse etiologies, either congenital
or acquired. The diagnosis was made through clinical examination and
radiological imaging (CT or MRI) over the duration from February 2022 to July
2023. Patients underwent intergroup comparisons based on age, hydrocephalus
etiology, and severity of hydrocephalus preoperatively. Inclusion criteria were
broadened to include patients above the age of 1 year, so the limitation of age
was eliminated in our study to compensate for the low number of cases available
and family refusal for the procedure. Choroid plexus coagulation and ETV were
then performed. Allprocedures were performed in the Pediatric Department of
Neurosurgery, Abo El Resh, Cairo University. All data were collected from the
patients’ files at the outpatient clinic or after admission
to wards, after the permission and explanation of the procedure, its outcome,
complications possible, and follow-up regimen prior to the data collection. This
study was carried out in accordance with the guidelines approved by the ethical
committee prior to this study's conduction.
Results:
Regarding the 60 pediatric patients who underwent Choroid plexus
coagulation as the main operation (in addition to septostomy in patients with
intact septum, ETV in most of the cases and lamina terminalis fenestration was
also documented in 15 patients) , where 51.7% were males, with a median age of
9.35 months. A percentage of 41.7%of cases were successful, while 51.7% ended
in failure. Inconclusive outcomes “Query success outcome” yielded 3.3%, and
3.3% were terminated intraoperatively due to extensive adhesions. Patients under
the age of one exhibited a success rate of 38.5%. The most prevalent presentation
observed was an increase in the circumference of the head, which accounted for
76.6% of cases. Head circumference greater than 50-55 cm displayed the highest
failure rate, with a 100% failure rate for exceeding 50cm under the age of 1 year.
Dandy-Walker variant also cases exhibited a 100% failure rate. Obstructive
hydrocephalus achieved 50% success, whereas communicating hydrocephalus
achieved 44.4%. Regarding intraoperative findings, patients with PHH had a
failure rate of 66.6%, PIH had 33.3% failure and 33.3% applied VP shunts
intraoperatively for extensive adhesions.Total follow up ranged between 0-538
days with a median of 70.5 days, and a mean of 162.3 days.
Conclusion:
In our preliminary study, we concluded that the performance of endoscopic
CPC/ETV in the management of infantile hydrocephalus can be influenced by
variable etiologies and different age groups. Fulfilling the correct pre-operative
data collection, including history taking and clinical examination is as important
as intraoperative findings to predict the possible outcome of CPC/ETV. Operating
on patients under 1 year of age and certain etiologies were explanatory variables
and predictors for failure outcomes in our study. A long-term, close follow up
period is recommended to detect any signs of failure and treated accordingly. كي الضفيرة المشيمية (CPC) هو إجراء جراحي يستخدم في علاج استسقاء المخ حيث يتم كي الضفيرة المشيمية بالمنظار لتقليل إنتاج السائل النخاعي. تمت دراسة 60 مريضًا من الأطفال المصابين بالاستسقاء في مستشفى أبو الريش للأطفال خلال الفترة من فبراير 2022 حتى يوليو 2023، حيث خضعوا لكي الضفيرة المشيمية. كانت المتابعة الدقيقة إلزامية لتقييم معدل النجاح والفشل ومدته. كان لدى المرضى الذين تقل أعمارهم عن سنة واحدة معدل فشل أعلى بنسبة 56.4٪ و66.6% لاستسقاء ما بعد النزيف ومحيط الرأس بين50-55 سم 66.7%.
Text in English and abstract in Arabic & English.
Neurosurgery Pediatrics
Endoscopy Choroid plexus coagulation (CPC) Endoscopic third ventriculostomy (ETV) Pediatrics Hydrocephalus
617.4810083
The role of Choroid plexus coagulation in management of hydrocephalus in pediatric patients / دور تجلط الضفيرة المشيمية بالكي في علاج استسقاء المخ لدى مرضى الأطفال / by Hala Emad Abd El Rahman Fahmy ; Under the supervision of Prof. Dr. Khaled Bassim Aly, Prof. Dr. Ehab Ahmed El Refaee, Dr. Mohamed Ahmed Ali Eissa Wahdan, Dr. Karim Abd El Aziz Mohamed. - 173 pages : illustrations ; 25 cm. + CD.
Thesis (M.Sc.)-Cairo University, 2023.
Bibliography: pages 158-173.
Hydrocephalus is a pathological condition characterized by the abnormal
accumulation of cerebrospinal fluid (CSF) within the ventricular system. The
accumulation of this fluid can occur due to either obstructed flow or impaired
absorption, with the most common causes being infection, intracranial
hemorrhage, or brain tumors. Recent hydrodynamic models propose that
hydrocephalus arises as a result of dysfunctional absorption of the CSF in the
subarachnoid and intraventricular spaces, leading to abnormally high amplitudes
of pulsation that can subsequently cause ventricular enlargement. The primary
treatment options for hydrocephalus are surgical in nature and include
ventriculoperitoneal shunt (VPS), endoscopic third ventriculostomy (ETV), and
endoscopic third ventriculostomy with choroid plexus cauterization (ETV-CPC)
(Pande et al.,2021)
Patients and Methods:
This study was conducted on 60 pediatric patients of both genders, who
presented with hydrocephalic changes due to diverse etiologies, either congenital
or acquired. The diagnosis was made through clinical examination and
radiological imaging (CT or MRI) over the duration from February 2022 to July
2023. Patients underwent intergroup comparisons based on age, hydrocephalus
etiology, and severity of hydrocephalus preoperatively. Inclusion criteria were
broadened to include patients above the age of 1 year, so the limitation of age
was eliminated in our study to compensate for the low number of cases available
and family refusal for the procedure. Choroid plexus coagulation and ETV were
then performed. Allprocedures were performed in the Pediatric Department of
Neurosurgery, Abo El Resh, Cairo University. All data were collected from the
patients’ files at the outpatient clinic or after admission
to wards, after the permission and explanation of the procedure, its outcome,
complications possible, and follow-up regimen prior to the data collection. This
study was carried out in accordance with the guidelines approved by the ethical
committee prior to this study's conduction.
Results:
Regarding the 60 pediatric patients who underwent Choroid plexus
coagulation as the main operation (in addition to septostomy in patients with
intact septum, ETV in most of the cases and lamina terminalis fenestration was
also documented in 15 patients) , where 51.7% were males, with a median age of
9.35 months. A percentage of 41.7%of cases were successful, while 51.7% ended
in failure. Inconclusive outcomes “Query success outcome” yielded 3.3%, and
3.3% were terminated intraoperatively due to extensive adhesions. Patients under
the age of one exhibited a success rate of 38.5%. The most prevalent presentation
observed was an increase in the circumference of the head, which accounted for
76.6% of cases. Head circumference greater than 50-55 cm displayed the highest
failure rate, with a 100% failure rate for exceeding 50cm under the age of 1 year.
Dandy-Walker variant also cases exhibited a 100% failure rate. Obstructive
hydrocephalus achieved 50% success, whereas communicating hydrocephalus
achieved 44.4%. Regarding intraoperative findings, patients with PHH had a
failure rate of 66.6%, PIH had 33.3% failure and 33.3% applied VP shunts
intraoperatively for extensive adhesions.Total follow up ranged between 0-538
days with a median of 70.5 days, and a mean of 162.3 days.
Conclusion:
In our preliminary study, we concluded that the performance of endoscopic
CPC/ETV in the management of infantile hydrocephalus can be influenced by
variable etiologies and different age groups. Fulfilling the correct pre-operative
data collection, including history taking and clinical examination is as important
as intraoperative findings to predict the possible outcome of CPC/ETV. Operating
on patients under 1 year of age and certain etiologies were explanatory variables
and predictors for failure outcomes in our study. A long-term, close follow up
period is recommended to detect any signs of failure and treated accordingly. كي الضفيرة المشيمية (CPC) هو إجراء جراحي يستخدم في علاج استسقاء المخ حيث يتم كي الضفيرة المشيمية بالمنظار لتقليل إنتاج السائل النخاعي. تمت دراسة 60 مريضًا من الأطفال المصابين بالاستسقاء في مستشفى أبو الريش للأطفال خلال الفترة من فبراير 2022 حتى يوليو 2023، حيث خضعوا لكي الضفيرة المشيمية. كانت المتابعة الدقيقة إلزامية لتقييم معدل النجاح والفشل ومدته. كان لدى المرضى الذين تقل أعمارهم عن سنة واحدة معدل فشل أعلى بنسبة 56.4٪ و66.6% لاستسقاء ما بعد النزيف ومحيط الرأس بين50-55 سم 66.7%.
Text in English and abstract in Arabic & English.
Neurosurgery Pediatrics
Endoscopy Choroid plexus coagulation (CPC) Endoscopic third ventriculostomy (ETV) Pediatrics Hydrocephalus
617.4810083