HCRN Endoscopic Versus Shunt Treatment of Hydrocephalus in Infants

Inclusion Criteria:

1. Corrected age <104 weeks and 0 days, AND

2. Child is ≥ 37 weeks post menstrual age, AND

3. Child must have symptomatic hydrocephalus, defined as: Ventriculomegaly on MRI (frontal-occipital horn ratio (FOR) >0.45, whichapproximates "moderate ventriculomegaly"), and at least one of the following:

• Head circumference >98th percentile for corrected age with either bulgingfontanelle or splayed sutures

• Upgaze paresis/palsy (sundowning)

• CSF leak

• Papilledema

• Tense pseudomeningocele or tense fluid along a track

• Vomiting or irritability, with no other attributable cause

• Bradycardias or apneas, with no other attributable cause

• Intracranial pressure (ICP) monitoring showing persistent elevation of pressurewith or without plateau waves AND

4. No prior history of shunt insertion or endoscopic third ventriculostomy (ETV)procedure (previous temporization devices and/or external ventricular drainspermissible)

Exclusion Criteria:

1. Hydrocephalus due to intraventricular hemorrhage in a child born before 37 weeksgestational age; OR

2. Anatomy not suitable for ETV+CPC or anteriorly placed ventriculoperitoneal shuntdefined as:

• Moderate to severe prepontine adhesions on steady state free precession (SSFP)or T2 weighted fast (turbo) spin echo (FSE/TSE) MRI, which includes thefollowing sequences: FIESTA, FIESTA-C, TrueFISP, CISS, Balanced FFE (bFFE),CUBE, SPACE, VISTA, IsoFSE, and 3D MVOX

• Closure of one or both foramina of Monro

• Thick floor of third ventricle (≥ 3mm)

• Narrow third ventricle (<5mm)

• Presence of scalp, bone, or ventricular lesions that make placement of ananterior shunt impracticable; OR

3. Underlying condition with a high chance of mortality within 12 months; OR

4. Hydrocephalus with loculated CSF compartments; OR

5. Peritoneal cavity not suitable for distal shunt placement; OR

6. Active CSF infection; OR

7. Hydranencephaly; OR

8. Child requires an intraventricular procedure (e.g. endoscopic biopsy) in addition tothe initial first-time permanent procedure for the treatment of hydrocephalus.