Challenges and outcome of cranial neuroendoscopic surgery in a resource constrained developing African country

Cranial neuroendoscopy has been safely applied to the surgical treatment of different lesions of the brain in our center since its introduction in September 2009. This article summarizes our experience with neuroendoscopy, highlighting the salient challenges and outcome.

A single institution, retrospective analysis of prospectively acquired cases over a 2.5-year period (September 2010 to February 2013). Challenges experienced during the course of patient care as well as complications and outcomes were recorded and analyzed using SPSS (SPSS Inc. Chicago IL, USA) version 17. Tests of statistical significance were set at 95% level.

Of the 291 cranial procedures performed during the study period, 37 (12.7%) were neuroendoscopic interventions. Patients were between the ages of 0.25 years and 25 years with a mean of 5.7 ± 1.5 years (95% confidence interval (CI)). Aqueductal stenosis was the most common indication for endoscopic intervention in 22 (59.5%) patients. Endoscopic third ventriculostomy was the most commonly performed neuroendoscopic procedure in 21 patients (56.7%). Major challenges experienced were patient dependent in 28 ± 1.0 patients (95% CL), learning curve related in 21 ± 0.4 patients, and poor endoscopy support infrastructure in 15 ± 0.5 patients. Complications were significantly more common in the first 6 months of neuroendoscopy (χ2= 7.57, df = 1, P< 0.05). Overall, 30 (81.1%) patients in our study experienced a positive outcome. The permanent morbidity and mortality rates in our series were 2.7% and 8.5%, respectively.

Highlighted are the myriad obstacles which interface the successful set up of neuroendoscopy service especially in resource-constrained settings. Endoscopic procedures become safer with experience and complications reduce significantly after a steep learning curve.