HCRN Endoscopic Versus Shunt Treatment of Hydrocephalus in Infants (ESTHI)
Hydrocephalus
About this trial
This is an interventional treatment trial for Hydrocephalus focused on measuring Hydrocephalus, Infants, Ventriculoperitoneal Shunt, ETV+CPC, endoscopic third ventriculostomy, choroid plexus cauterization
Eligibility Criteria
Inclusion Criteria:
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)
Exclusion Criteria:
- Hydrocephalus due to intraventricular hemorrhage in a child born before 37 weeks gestational age; OR
Anatomy not suitable for ETV+CPC or anteriorly placed ventriculoperitoneal shunt defined as:
- Moderate to severe prepontine adhesions on steady state free precession (SSFP) or T2 weighted fast (turbo) spin echo (FSE/TSE) MRI, which includes the following 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 an anterior shunt impracticable; OR
- Underlying condition with a high chance of mortality within 12 months; OR
- Hydrocephalus with loculated CSF compartments; OR
- Peritoneal cavity not suitable for distal shunt placement; OR
- Active CSF infection; OR
- Hydranencephaly; OR
- Child requires an intraventricular procedure (e.g. endoscopic biopsy) in addition to the initial first-time permanent procedure for the treatment of hydrocephalus.
Sites / Locations
- Children's of AlabamaRecruiting
- Children's Hospital of Los AngelesRecruiting
- Children's Hospital ColoradoRecruiting
- Wolfson Children's HospitalRecruiting
- Arnold Palmer Hospital for ChildrenRecruiting
- Johns Hopkins Children's CenterRecruiting
- St. Louis Children's HospitalRecruiting
- Nationwide Children's HospitalRecruiting
- Children's Hospital of Pittsburgh of UPMCRecruiting
- The Pennsylvania State University
- Monroe Carell Jr. Children's Hospital at VanderbiltRecruiting
- Texas Children's HospitalRecruiting
- Primary Children's HospitalRecruiting
- Seattle Children's HospitalRecruiting
- Alberta Children's HospitalRecruiting
- British Columbia Children's HospitalRecruiting
- The Hospital for Sick ChildrenRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
ETV+CPC
Ventriculoperitoneal Shunt
Subjects randomized to this arm will undergo an ETV+CPC procedure for treatment of Hydrocephalus
Subjects randomized to this arm will undergo a Ventriculoperitoneal Shunt procedure for treatment of Hydrocephalus