What is Choroid Plexus Cauterization for Hydrocephalus?

In the treatment of congenital hydrocephalus, choroid plexus cauterization (CPC) is a surgical procedure used to slow down the brain’s production of cerebrospinal fluid (CSF) ^[1].

To understand how it works, it helps to know about the choroid plexus. This is a small, specialized tissue located deep inside the brain’s ventricles (fluid-filled spaces) that acts as the primary “factory” for producing CSF ^[2]. In a baby with hydrocephalus, fluid builds up faster than it can be drained or absorbed.

During CPC, a neurosurgeon uses a specialized tool with a mild electrical current to precisely cauterize (use heat to safely seal off) portions of the choroid plexus ^[1][3]. This is a minimally invasive procedure; the surgeon accesses the ventricles through a small opening in the skull using a thin, flexible tube with a tiny camera, called an endoscope. This allows them to target the choroid plexus with microscopic precision without harming the surrounding brain tissue. By doing this, they permanently reduce the tissue’s ability to make fluid ^[1].

The “Faucet and Drain” Approach

CPC is rarely performed on its own. Instead, it is almost always paired with an Endoscopic Third Ventriculostomy (ETV), a procedure that creates a new bypass pathway for fluid to drain around blockages in the brain ^[4].

Think of hydrocephalus like a sink where the faucet is running and the drain is clogged:

• The ETV creates a new drain.
• The CPC turns down the faucet.

Why is CPC Added for Infants?

While an ETV alone is often highly successful in older children and adults, it has a lower success rate in babies under one year old ^[5]. This is because an infant’s underdeveloped brain often cannot reabsorb the redirected fluid fast enough to keep up with how quickly the choroid plexus produces it ^[5].

By adding the CPC step to reduce the overall volume of fluid being made, the new ETV pathway has a much better chance of handling the fluid load ^[5][4]. Research shows that combining ETV with CPC significantly increases the chances of a successful outcome for infants ^[5]. This includes infants with structural causes like spina bifida (myelomeningocele), as well as those with non-postinfectious causes such as aqueductal stenosis ^[5].

Goals and Next Steps

The main goal of the ETV-CPC procedure is shunt independence—allowing a baby to manage their hydrocephalus without needing a permanent mechanical tube (VP shunt) implanted in their body ^[4][6].

While this combination surgery offers a chance at avoiding a lifetime of shunt revisions, it does carry risks. Because the choroid plexus is full of blood vessels, there is a risk of bleeding (hemorrhage) during the procedure, alongside other surgical risks like infection, fluid leaks, or seizures ^[7][8].

There is also the chance that the procedure simply won’t be enough to control the fluid buildup ^[7]. If the ETV-CPC is not successful, the standard next step is usually to place a traditional shunt ^[9]. Because you will be looking out for signs of fluid buildup after going home, your care team will provide a specific list of warning signs—such as a bulging soft spot or extreme fussiness—that indicate the procedure might be failing.