The impact of combined endoscopic third ventriculostomy and choroid plexus cauterization on the management of pediatric hydrocephalus in developing countries.

Abstract

There are potentially 100,000 to 200,000 new cases of infant hydrocephalus each year in sub-Saharan Africa alone. The difficulty of accessing urgent neurosurgical care in this region substantially magnifies the risk of serious morbidity and death from shunt malfunction. Endoscopic third ventriculostomy is an excellent treatment alternative to shunt placement, but its effectiveness in young infants is substantially reduced. Combining endoscopic third ventriculostomy with bilateral endoscopic choroid plexus cauterization has emerged as a significantly more successful treatment option for infant hydrocephalus. In Uganda, two thirds of infants younger than age 1 year and more than three fourths of children older than age 1 year undergoing the procedure have successfully avoided shunt dependence. Nearly all failures occur in the first 6 months, which, for infants, is a relatively safe time as treatment failure is visible to the mother and the need for intervention is less urgent. Clinical parameters have been identified that help predict the likelihood of treatment failure in a given patient. The broader impact of this technique on the management of pediatric hydrocephalus in the developing world will be dependent on demonstration of its success when implemented by other surgeons in different patient populations, and the extent to which this treatment paradigm is ultimately adopted.