A Shuntless Technique for Treating Hydrocephalus

A Shuntless Technique for Treating Hydrocephalus

MUSC Children’s Health pediatric neurosurgeon Ramin Eskandari, M.D.,discusses a new shuntless procedure for treating hydrocephalus — endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC). As chief resident at the University of Utah, Eskandari was one of the first residents in the U.S. to travel to Uganda, where the technique was developed, for training.

In Uganda, as in other Sub-Saharan countries, the survival rate for hydrocephalus has been abysmal because of high infection rates and limited access to medical care. In 2000, Benjamin C. Warf, M.D., an American neurosurgeon working in Uganda, began to look for a solution. The advent of the flexible endoscope led Warf to revisit an old surgical technique wherein a hole is created in the floor of the third ventricle to reroute excess CSF followed by shrinkage of the choroid plexus to temporarily reduce CSF production. This approach allows the brain to gradually reabsorb the extra CSF and establish a new equilibrium. While historically the technique was performed as an open brain surgery, Warf advanced the method into a minimally invasive procedure by conducting the surgery with a flexible endoscope through a small hole in the skull. Today, the ETV/CPC method is the mainstay for hydrocephalus treatment in Sub-Saharan Africa and is of growing interest to neurosurgeons in developed countries.


July 20, 2017

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The Medical University of South Carolina