Comparison of Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization Combined and Alone in Peadiatric Hydrocephalus – A Randomized Control Trial

Objective:  To evaluate whether combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) improves treatment outcomes in pediatric hydrocephalus compared to ETV alone. Materials and Methods:  This prospective cohort study was conducted at the Department of Neurosurgery, DHQ Hospital, Rawalpindi, Pakistan, over 6 months. Pediatric patients diagnosed with hydrocephalus and meeting inclusion criteria were enrolled and assigned to two cohorts based on the procedure performed: Cohort A (ETV alone, n=35) and Cohort B (ETV + CPC, n=35). Patients were followed for three months postoperatively to assess treatment success, need for reoperation, and mortality. Relative risks (RR) with 95% confidence intervals (CI) were calculated to compare outcomes between cohorts. Results:  The success rate was significantly higher in the ETV + CPC cohort (85.7%) compared to the ETV-alone cohort (45.7%) (RR = 1.87, 95% CI: 1.31–2.66, p<0.001).** The reoperation rate was lower in the ETV + CPC group (8.6% vs. 34.3%, p=0.009), as was mortality (2.9% vs. 20.0%, p=0.024). Conclusion:  The addition of CPC to ETV is associated with significantly improved outcomes in pediatric hydrocephalus, reducing failure rates, need for reoperation, and mortality. These findings support CPC as an effective adjunct to ETV. Further long-term studies are warranted to confirm these benefits.