Pediatric Neurosurgery; Endoscopic Third Ventriculostomy (ETV) with Choroid Plexus Coagulation (CPC)

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SUMMARY:  Drs. Samer Elbabaa of the Orlando Children's Hospital and Ben Mutiso from the Kijabe Mission Hospital in Kijabi, Kenya  discuss their experience with Endoscopic Third Ventriculostomy (EVT) and Choroid Plexus Coagulation (CPC)  in the treatment of Childhood Hydrocephalus. In LMIC, patients present delayed with Macrocephaly, and associated Neural tube defects. In most countries  patients are treated with shunts of which 20-30% fail the first year and 85% in 5 years.  EVT are done commonly world wide but Choroid Plexus Coagulaton is done in only 10 centers in Africa as it is a new procedure with a 20 case learning curve. For patients with Spina bifida and Myelomeningocoele, early in-utero treatment with EVT+CPC has better results that are longer lasting with 78% becoming shunt independent.  Coagulation of the Choroid Plexus is performed rather than Choroid Plexectomy because of the lower complications associated with the coagulation. Coagulation seems is not followed by regrowth of the plexus epithelium, so the results of coagulation last for years without further treatment. Mortality and Morbidity is less than 1% with CPC. Dr. Mutiso describes the surgical steps  he takes in performing this operation in detail with good imaging examples. The patient is always prepared for a VP shunt in case the procedure cannot be done. Dr. Elbabaa summarizes his experience with intra-uterine fetal surgery for myelomeningocoele, being among one of the few centers world-wide doing this work in large volumes. Both discuss the complications of ETV-CPC. A wide ranging interchange among the audience and presenters is very  informative. This is a first rate review of the subject which is, besides ICH, the most common neurosurgical disease in the world now upgraded by new technology and infomation.  Cost savings and quality of life improvements are significant. More neurosurgeons need to be educated about the ETV-CPC procedure.  These presentations and Discussion last 80 minutes, well worth your time. How can you learn to do ETV and CPC? Watch this lecture-discussion, visit a center and  see them done, buy the flexible endoscope, work in the autopsy room and begin the procedure as initial steps, and inform your patients of your experience and their choices.  (JIA-10/10/24)

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