For infants with hydrocephalus, a combined procedure called ETV with choroid plexus cauterization (ETV/CPC) has become an important option. It pairs the shunt-free approach of ETV with a second step that reduces CSF production, improving the odds of success in babies. Understanding it helps parents weigh their child's options.
The two parts of the procedure. ETV/CPC combines:
- ETV (endoscopic third ventriculostomy) — creating a new opening in the floor of the third ventricle so CSF can bypass a blockage and reach the spaces where it's absorbed (as described in the previous article).
- CPC (choroid plexus cauterization) — using the endoscope to cauterize (gently burn) parts of the choroid plexus, the tissue that produces CSF. Reducing the amount of choroid plexus lowers CSF production, helping balance the equation between how much fluid is made and how much the baby can absorb.
Both steps are done together during a single endoscopic procedure, through a small opening in the skull.
Why combine them, especially in infants ETV alone has a lower success rate in very young babies than in older children and adults. Adding CPC — reducing fluid production — improves the chances that the procedure will adequately control the hydrocephalus in infants. The combination emerged as a way to extend the benefits of a shunt-free approach to babies, in whom shunts carry particular long-term burdens (more years of potential complications and revisions over a lifetime).
The appeal: avoiding a shunt As with ETV alone, the major attraction of ETV/CPC is the possibility of treating hydrocephalus without a shunt — sparing a child (potentially) a lifetime of shunt dependence, with its risks of blockage, infection, and repeated revision surgeries. For families, avoiding or delaying a shunt can be a meaningful goal.
The honest picture ETV/CPC is valuable but not a guaranteed solution:
- Success varies with the child's age, the cause of hydrocephalus, and anatomy.
- Both ETV/CPC and shunts can fail and require further surgery. Research suggests the patterns of failure differ — for instance, the timing of when failures tend to occur can differ between ETV/CPC and shunts — and there's no universal "winner"; the best choice depends on the individual child.
- If ETV/CPC doesn't adequately control the hydrocephalus, a shunt can still be placed afterward.
- It carries surgical risks, which the neurosurgeon will discuss.
How the choice is made Deciding between ETV/CPC and a shunt for an infant involves weighing the likelihood of success (based on the child's specifics), the goal of avoiding shunt dependence, and the family's circumstances and preferences, in discussion with an experienced pediatric neurosurgeon. Specialized centers and pediatric neurosurgery research networks have studied these procedures extensively to guide decisions.
What parents should know If ETV/CPC is being considered for your baby:
- Ask about the estimated chance of success for your child's specific situation.
- Understand that close follow-up is essential, since the procedure can fail over time and hydrocephalus can recur.
- Know the warning signs that the hydrocephalus may be returning (the same signs of infant hydrocephalus), so you can seek care promptly.
- Remember that a shunt remains available as a backup if needed.
The takeaway ETV/CPC is a thoughtful, shunt-free option for infants that combines creating a new CSF pathway with reducing CSF production. For suitable babies, it offers the chance to avoid or delay shunt dependence — with the understanding that success varies, close monitoring is needed, and a shunt can still be placed if the procedure doesn't fully control the hydrocephalus.