Cauterização endoscópica do plexo corióideo versus derivação ventrículo-peritoneal na hidranencefalia e hidrocefalia extrema

Abstract

Hydranencephaly and near hydranencephaly are two different types of hydrocephalus that share a single main feature: the extremely large size of the ventricular system. Both conditions demand prompt treatment as soon as evidence of increased intracranial pressure appears or excessive head growth develops.Standard management has been cerebrospinal fluid (CSF) diversion using a ventriculoperitoneal shunt (VPS), which attempts to slow rapid head growth as well as relieve patient discomfort from increased intracranial pressure. But shunts have been associated with many complications, especially in patients with hydranencephaly or near hydranencephaly. The objective of our study was to prospectively evaluate endoscopic choroid plexus cauterization (ECPC) and ventriculoperitoneal shunts (VPSs) in infants with hydranencephaly or near hydranencephaly, focusing on the feasibility, costs and complications. We prospectively collected clinical data from all untreated hydranencephalic and near hydranencephalic children from October 2006 to March 2008. All patients treated during this period were randomly divided into 2 groups, ECPC or VPS. Seventeen patients were entered into the study. ECPC was completed in 9 patients; the procedure successfully controlled excessive head circumference and signs of increased intracranial pressure in eight (80%) of these patients. There were no complications related to this method of treatment. Seven children were randomized to the VPS group; of these, two patients (28.5%) required shunt revisions during follow-up. There were no complications related to shunt placement. ECPC is as effective as VPS for treatment of hydranencephaly and near hydranencephaly. and more economical. ECPC is an acceptable alternative to ventriculoperitoneal shunting for treatment of hydranencephaly and near hydranencephaly.