Inclusion criteria:

1. Age less than six months
2. Symptomatic hydrocephalus characterized by abnormal rate of head growth, full anterior fontanel, ventriculomegaly
3. A parent or a guardian qualified by Ugandan law to give informed consent
4. Patients from Eastern, Central and Northern districts of Uganda, and in geographic proximity to CURE hospital will be eligible

Exclusion criteria:

1. Age greater than six months
2. No evidence of progressive hydrocephalus
3. Patients outside of the districts specified in the inclusion criteria

Inclusion criteria:

1. Born at GA ≥ 37 weeks
2. Age less than six months at the time of enrollment
3. No known medical conditions
4. With a parent or a guardian qualified by Ugandan law to give informed consent
5. Parents live in one of the villages in the Mbale or Budaka District, in geographic proximity to CCHU.

Exclusion criteria:

1. Born at GA < 37 weeks
2. Age greater than six months
3. Evidence of one or more medical conditions
4. Living outside of the districts specified in the inclusion criteria.

The Endoscopic Third Ventriculostomy/Choroid Plexus Cauterization (ETV/CPC) will comprise a standard frontal approach with flexible endoscopy.

Scores on the BSID-3, which is used to evaluate infants and toddlers 1 to 42 months of age, range from 1 to 19, with higher scores indicating better performance; the mean (±standard deviation(SD)) score in the general population is 10±3.

Treatment failure or success will be determined with the use of clinical and radiographic criteria.

• Treatment success will be determined as the shift in the growth of head circumference to a normal rate, as plotted on a standard growth chart; decompression of the anterior fontanel; relief of symptoms of elevated intracranial pressure, such as irritability and vomiting; resolution of down-gaze or sixth cranial nerve palsy; and a decrease or arrest in ventriculomegaly as determined on Computerized Tomography (CT).
• Treatment failure will be defined as treatment-related death or the need for a second operation for infection or for the recurrence of hydrocephalus.

cerebral oxygen metabolism will be measured with near-infrared spectroscopy

brain volume will be quantitatively estimated from the head CT scan