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Children hydrocephalus in Togo: etiologies, treatment, and outcomes
Essossinam Kpélao1, Kodjo M Hobli Ahanogbé1, Komi Egu1
1Neurosurgery Unit, Essossinam KPELAO, CHU SO, Lomé, Togo.
Insights
Congenital malformations are the primary cause of hydrocephalus in African children, leading to significant psychomotor delays and mortality. While maternal infections play a role, congenital factors dominate, highlighting ongoing challenges in managing pediatric hydrocephalus.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Public Health in Africa
Background:
- Hydrocephalus is a prevalent neurological condition in sub-Saharan Africa.
- Postinfectious hydrocephalus cases are declining.
- Understanding current etiologies and outcomes is crucial.
Purpose of the Study:
- To identify the primary causes of hydrocephalus in children.
- To evaluate the outcomes of hydrocephalus treatment.
- To analyze trends in pediatric hydrocephalus in Lomé, Togo.
Main Methods:
- Retrospective study of 305 hydrocephalus cases (0-15 years) from 2012-2021.
- Data collected on patient demographics, maternal health, clinical signs, etiologies, surgical methods, and outcomes.
- Outcomes assessed at 1 year, categorizing psychomotor development as normal or delayed.
Main Results:
- Congenital malformations accounted for 68.5% of hydrocephalus cases.
- Macrocephaly was the most common clinical sign (91.5%).
- Significant psychomotor retardation (61.8%) was observed at 1 year, with a notable mortality rate.
Conclusions:
- Congenital causes are predominant in African hydrocephalus, though maternal infections contribute.
- The morbidity and mortality associated with hydrocephalus remain high.
- Neurocognitive outcomes require significant attention and improvement.
Background:
Hydrocephalus is frequent in sub-Saharan African countries. The postinfectious hydrocephalus tends to decrease. The objective of this study was to identify the etiologies and outcomes of hydrocephalus.
Methods:
This was a retrospective study of hydrocephalus cases (0-15 years old) treated in the neurosurgery unit of the Sylvanus Olympio Hospital in Lomé over 10 years (2012-2021). At 1 year, the evolution distinguished in two categories: (1) Good psychomotor development: no delay in the acquisition of walking, language, and school. (2) Psychomotor delay: delay in the acquisition of walking, language, and school.
Results:
We reported 305 children treated for hydrocephalus representing 1.8% of all neurosurgery unit patients and 34.2% of pediatric pathologies. There was a male predominance (60.6%). We noted second degree consanguinity in 8.5%. The positive maternal serologies were HIV (12.4%), syphilis (8.2%), and toxoplasmosis (2.6%). A malaria episode had been treated during the first trimester in 36.7% of the mothers. The main clinical sign of hydrocephalus was 91.5% of Macrocephalus. Congenital Malformafions were the most common etiologies of hydrocephalus (68.5%). Ventriculoperitoneal shunt was the main surgical method used and 16 deaths were recorded. The medium-term evolution (1 year) was evaluated in 36.1% and noted 61.8% of psychomotor retardation.
Conclusion:
This study confirms the trend of the predominance of congenital causes of hydrocephalus in Africa, even if maternal infections can be involved in the development of some of them. The morbimortality of this pathology remains important, especially concerning neurocognitive outcomes.
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