Efficacy of Combined Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization in Treatment of Hydrocephalus

July 28, 2026 updated by: Ebrahim Ahmed Yousof Abdelhakeem, Assiut University

Efficacy of Combined Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization as Primary Treatment for Paediatric Hydrocephalus

Hydrocephalus remains one of the most common conditions encountered in neurosurgery, traditionally managed by ventriculoperitoneal (VP) shunting. Despite its effectiveness, shunt dependency is associated with certain complications including infection, obstruction, and repeated revisions, leading to increased morbidity and healthcare burden.

Over the last 70 years, cerebrospinal fluid (CSF) shunting and more recently endoscopic third ventriculostomy (ETV) have been the mainstays of hydrocephalus treatment. In recent years, choroid plexus cauterization (CPC) has re-emerged as an additional treatment strategy.

In combination with ETV, CPC increases the chances of successfully treating some cases with hydrocephalus, than ETV alone.

Endoscopic Third Ventriculostomy (ETV) has emerged as an alternative physiological treatment by creating a bypass for cerebrospinal fluid (CSF) flow. However, its success is limited in infants and in other varieties of hydrocephalus. The addition of Choroid Plexus Cauterization (CPC), which reduces CSF production, has been shown to improve outcomes when combined with ETV, particularly in younger patients.

The idea is based on the principle that ablation of the predominant source of CSF secretion within the brain, choroid plexus (CP), reduces CSF production. In addition, CPC may reduce CSF pulsatility, an effect which may be potentiated when combined with ETV, which might reduce intraventricular pulsations by serving as a pulsation absorber. These effects, in combination, may tip the balance in favour of CSF absorption and negate the need for shunting in a proportion of patients.

The combined ETV-CPC approach, popularized by Benjamin Warf, has demonstrated promising results in reducing shunt dependence, especially in resource-limited settings. However, variability in success rates persists due to differences in patient selection, etiology, and surgical expertise.

This study aims at evaluation of the efficacy of combined ETV-CPC as a primary treatment modality for hydrocephalus and to identify predictors of surgical success and failure, thereby optimizing patient selection and improving outcomes.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

90

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Egypt
    • Asyut Governorate
      • Asyut, Asyut Governorate, Egypt, 71515
        • Assuit University Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Children below 18 years
  • Radiologically diagnosed obstructive hydrocephalus
  • Late onset aqueductal stenosis cases

Exclusion Criteria:

  • Communicating hydrocephalus.
  • Acute interventricular haemorrhage cases
  • Active infection cases
  • Multilocular hydrocephalus cases
  • Previous CSF diversion cases

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Combined ETV & CPC
  1. History: A complete medical history will be taken from the mother, including age when diagnosed, history of NICU admission, history suggestive of infection, other congenital anomalies or family history and any neurological symptoms.

  2. Through physical examination:

    • General examination including blood pressure, heart rate, respiratory rate, temprature.
    • Neurological examination especially for GCS, anterior fontanelle, head circumference, cranial nerve affection and mental and physical growth.
    • Visual assessment.

  3. Investigations

    • Radiology: CT brain and/or MRI brain with CSF flowmetry.
    • Laboratory investigations like CBC, PT, PC,INR, renal enzymes and preoperative fitness.
  4. Treatment modatities: Surgical strategy; ETV in combined with thermal cauterization of visible choroid plexus.
Procedure: Combined endoscopic third ventriculostomy & coroid plexus cauterization
Using ETV & CPC in paediatric hydrocephalus will reduce Complications as CSF leak and Infection, Hospital stay, Evaluate time to failure, Compare outcomes across different hydrocephalus aetiologies and Medical care cost.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
2. shunt-free survival
Time Frame: 2 years minimumly
The period that patients underwent ETV & CPC stays without need for shunt
2 years minimumly

Secondary Outcome Measures

Outcome Measure
Time Frame
Change in health care burden of paediatric hydrocephalus
Time Frame: 2 years minimumly
2 years minimumly
Change in rate of hospital admissions
Time Frame: 2 years minimumly
2 years minimumly

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

July 1, 2026

Primary Completion (Estimated)

August 1, 2027

Study Completion (Estimated)

August 1, 2029

Study Registration Dates

First Submitted

July 23, 2026

First Submitted That Met QC Criteria

July 28, 2026

First Posted (Actual)

July 30, 2026

Study Record Updates

Last Update Posted (Actual)

July 30, 2026

Last Update Submitted That Met QC Criteria

July 28, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ETV & CPC in hydrocephalus

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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