RESUMO
INTRODUCTION: The standard treatment for hydranencephaly and maximal hydrocephalus consists of inserting shunts, although complications frequently occur. Choroid plexus cauterization (CPC) is an alternative, but its long-term efficacy and the factors associated with the success and failure of controlling head circumference (HC) are not well defined. OBJECTIVE: This study aims to evaluate the long-term efficacy and factors related to the success rate of CPC in the treatment of hydranencephaly and maximal hydrocephalus. METHOD: Forty-two children with maximal hydrocephalus and hydranencephaly underwent CPC from 2006 to 2014 and were retrospectively evaluated. Children with less than 3 months of follow-up were excluded. The long-term efficacy and success rate of possible variables (i.e., sex, type of malformation, type of surgery performed, treatment hospital, age, and HC at the time of surgery and birth) were evaluated. RESULTS: Thirty-four children were considered for the effectiveness analysis. Treatment was successful in 24 children (70.6%), and failure occurred in 10 children (29.4%). Failure was detected soon after the endoscopic procedure (average 116 days). There was no difference in effectiveness when comparing the age at the moment of surgery (p = 0.473), type of malformation (p = 1), HC at birth (0.699), and HC at the time of surgery (p = 0.648). The surgical death rate was 7.14%. CONCLUSION: Endoscopic CPC was a valid procedure used to treat hydranencephaly and maximal hydrocephaly, and it was effective in 70.6% of cases, with an average follow-up period of 32 months. When failures occurred, they occurred early. None of the analyzed variables interfered with the success of the treatment.
Assuntos
Cauterização/métodos , Plexo Corióideo/cirurgia , Hidranencefalia/cirurgia , Hidrocefalia/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Neuroendoscopia/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Objetivos: Descrever a técnica de coagulação neuroendoscópica do plexo coroide e divulgá-la como opção de tratamento primário da hidranencefalia e da hidrocefalia extrema. Mostrar a casuística de coagulação endoscópica de plexo coroide do Serviço de Neurocirurgia do Hospital da Baleia em BeloHorizonte, MG, Brasil. Métodos: Imagens tomográficas foram avaliadas por um neurocirurgião, sendo selecionadas crianças portadoras de hidranencefalia e hidrocefalia extrema com cavidade ventricular única. Os pacientes foram acompanhados por até três anos no pós-operatório. Resultados: Foram tratadas seis crianças com hidranencefalia e seis com hidrocefalia extrema. Um paciente faleceu na primeira semana de pós-operatório em função de choque hipovolêmico e hipernatremia graves e outro cursou com aumento progressivo do perímetro cefálico e necessidade de derivação ventriculoperitoneal. Um terceiro paciente apresentou óbito tardio não relacionado à cirurgia endoscópica. Os demais apresentaram evolução adequada no pós-operatório. Conclusão: A coagulação endoscópica do plexo coroide mostrou-se alternativa eficaz no tratamento da hidranencefalia e da hidrocefalia extrema.
Objectives: Describing the neuroendoscopic technique for coagulation of the choroid plexus and publicize it as an option for the primary treatment of extreme hydrocephalus and hydranencephaly. Display the series of endoscopic coagulation of the choroid plexus of the Neurosurgery Department of the Hospital da Baleia in Belo Horizonte, MG, Brazil. Methods: Tomographic images were used to select children with hydranencephaly and extreme hydrocephalus with single ventricular cavity. Patients were followed for up to three years postoperatively. Results: Six children with hydranencephaly and six with extreme hydrocephalus were treated. One patient died in the first week postoperatively due to hypovolemic shock and severe hypernatremia and another developed progressive increase in head circumference and the need for ventriculoperitoneal shunt. A third patient had late death unrelated to endoscopic surgery. The others had adequate postoperative evolution. Conclusion: The endoscopiccoagulation of the choroid plexus is an effective alternative in the treatment of extreme hydrocephalus and hydranencephaly
Assuntos
Humanos , Masculino , Feminino , Criança , Plexo Corióideo , Hidranencefalia/sangue , Hidranencefalia/cirurgia , Hidrocefalia/sangue , Hidrocefalia/cirurgia , NeuroendoscopiaRESUMO
OBJECTIVE: To prospectively evaluate the results of endoscopic choroid plexus cauterization (ECPC) and ventriculoperitoneal shunts (VPSs) in infants with hydranencephaly or near hydranencephaly. METHODS: We prospectively collected clinical data from all untreated hydranencephalic and near hydranencephalic children from October 2006 to March 2008. All patients treated were randomly divided into 2 groups, ECPC or VPS, and submitted to either endoscopic choroid plexus cauterization or ventriculoperitoneal shunt placement. RESULTS: 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 8 of these patients (88.8%). One endoscopic procedure in a hydranencephalic child failed after 7 months, resulting in VPS placement. Thus, of the 10 patients randomized to ECPC, 8 were treated successfully by ECPC (80%), and 2 went on to have a VPS. There were no complications related to this method of treatment. Seven children were randomized to the VPS group; and of these, 2 patients (28.5%) required shunt revisions during follow-up. There were no complications related to shunt placement. There was no difference in the success rate between patients randomized to ECPC and VPS, but the ECPC was more economical. CONCLUSION: ECPC is an acceptable alternative to VPS for treatment of hydranencephaly and near hydranencephaly. It is a single, definitive, safe, effective, and economical treatment that may avoid the complications of shunting.