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%.