Outcomes of Implementation of the CURE Protocol for Treating Pediatric Hydrocephalus: An Institutional Experience

Abstract Background Paediatric hydrocephalus imposes a significant clinical and financial burden in developing countries, this study aims to assess the efficacy and safety of endoscopic third ventriculostomy (ETV), either alone or combined with choroid plexus cauterization (CPC), for preventing shunt dependence in paediatric hydrocephalus within a healthcare setting of a tertiary hospital in Egypt. Patients and Methods This prospective clinical case series included Patients ≤16 years old with clinical signs and/or symptoms of hydrocephalus requiring CSF diversion and accessibility for follow-up. Cases with active infection or brain imaging showing anatomical distortion or multiloculated hydrocephalus were excluded. Failed ETV+/-CPC cases were categorized into early and late failure groups, each with specific management strategies. Results Forty patients admitted to Ain Shams University Hospitals between March 2022 and August 2023. underwent ETV+/-CPC using a flexible neuroendoscope. Aqueductal stenosis was the most common etiology, observed in 13 patients (32.5%), followed by myelomeningocele in 11 patients (27.5%), and post-infectious causes in 6 patients (15.0%). The median age of the patients was 5.05 months. Twenty-five patients (62.5%) achieved successful outcomes following ETV/CPC procedures, with no procedure-related morbidity or mortality events observed. Fifteen patients (37.5%) experienced ETV failure, of whom 6 underwent ETV redo procedures. Twenty-eight patients (70%) remained shunt-free in the study cohort. The mean follow-up duration was 12 months. Conclusion ETV/CPC demonstrates effectiveness in decreasing the necessity for shunt placement across various patient demographics. Moreover, it supports a sustainable and cost-effective approach to hydrocephalus treatment.