Endoscopic Versus Shunt Treatment of Hydrocephalus in Infants
Hydrocephalus is a potentially debilitating neurological condition that primarily affects babies under a year of age and has traditionally been treated by inserting a shunt between the brain and the abdomen. A newer endoscopic procedure offers hope of shunt- free treatment that may reduce complications over a child's life, but it is not clear if the endoscopic procedure results in similar intellectual outcome as shunt. Therefore, the investigators propose a randomized trial to compare intellectual outcome and brain structural integrity between these two treatments, to help families make the best treatment decision for their baby.
• Corrected age \<104 weeks and 0 days,
• AND
• Child is ≥ 37 weeks post menstrual age,
• AND
• Child must have symptomatic hydrocephalus, defined as:
• Ventriculomegaly on MRI (frontal-occipital horn ratio (FOR) \>0.45, which approximates moderate ventriculomegaly), and at least one of the following:
⁃ Head circumference \>98th percentile for corrected age with either bulging fontanelle 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 pressure with or without plateau waves
• AND
• No prior history of shunt insertion or endoscopic third ventriculostomy (ETV) procedure (previous temporization devices and/or external ventricular drains permissible)