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The pattern and outcome of infants and neonates undergoing endoscopic third ventriculostomy in Tanzania: an
Consolata S Shayo1, Chibuikem Anthony Ikwuegbuenyi2, Romani R Sabas1,2
11Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; and.
Insights
Endoscopic third ventriculostomy (ETV) and ETV with choroid plexus cauterization (CPC) show promising outcomes for infant hydrocephalus in East Africa. These procedures appear more effective than shunting in neonates, offering a viable treatment option.
Area of Science:
- Pediatric Neurosurgery
- Global Health
- Medical Technology
Background:
- Hydrocephalus affects over 100,000 infants annually in sub-Saharan Africa, posing a significant public health challenge.
- Endoscopic third ventriculostomy (ETV) is a preferred treatment for obstructive hydrocephalus, but data on its efficacy in infants under 2 months is limited.
Purpose of the Study:
- To evaluate the presentation patterns, endoscopic anatomy, and clinical outcomes of ETV in infants younger than 6 months in East Africa.
- To compare the outcomes of ETV and ETV with choroid plexus cauterization (CPC) in this cohort.
Main Methods:
- A retrospective cohort study analyzed data from 325 infants under 6 months who underwent ETV or ETV/CPC from 2012 to 2020.
- Data collected included demographics, presentation, etiology, endoscopic anatomy, treatment type, and clinical outcomes (ETV success and failure).
- Univariate/multivariate logistic regression was used to identify predictors of outcomes.
Main Results:
- The study included 325 infants (62% male, median age 86 days); 69% had congenital hydrocephalus.
- ETV success rates at 4 weeks were higher in infants younger than 2 months (0.95) compared to those older (0.88; p=0.022).
- No significant differences in success or failure rates were observed at 26 or 52 weeks between age groups.
Conclusions:
- ETV and ETV/CPC demonstrate favorable clinical outcomes in African neonates with hydrocephalus, potentially outperforming ventriculoperitoneal shunting.
- While initial success rates varied by age, long-term outcomes were comparable, suggesting ETV/CPC as a valuable treatment option.
Objective:
Hydrocephalus in infants is a substantial public health burden in East Africa. In sub-Saharan Africa, hydrocephalus is estimated to affect more than 100,000 new infants annually. Endoscopic third ventriculostomy (ETV) is considered a safe procedure and is a method of choice for the treatment of obstructive hydrocephalus. ETV outcomes in children older than 2 years are abundant; however, minimal outcomes data for infants and neonates younger than 2 months are available in the literature. The authors therefore sought to evaluate the patterns of presentation, endoscopic anatomy, and clinical outcomes in a cohort of infants younger than 6 months who underwent ETV at a major East African center.
Methods:
A retrospective cohort study was conducted using prospectively collected data from all patients with hydrocephalus who were younger than 6 months and underwent ETV or ETV with choroid plexus cauterization (CPC) at Muhimbili Orthopaedic Institute from June 2012 to December 2020. Demographic and clinical data were collected and included age, presentation, etiology, endoscopic anatomy, type of treatment, and clinical outcome. The primary outcomes were 1) ETV success and 2) ETV failure. Predictors of each outcome were assessed through univariate/multivariate logistic regression.
Results:
Of the 325 infants treated for hydrocephalus, 62% were male, with a median age of 86 days; 69% of the infants presented with congenital hydrocephalus, 37% underwent ETV, and 48% underwent ETV/CPC. The ETV success rate at 4 weeks postoperatively was statistically significantly lower among infants aged 2 months or older compared with those younger than 2 months (0.88 vs 0.95, p = 0.022). No difference was seen 26 weeks postoperatively (0.63 vs 0.73, p = 0.116). At the 52nd week, the failure rates were 0.60 for infants aged 2 months or older versus 0.62 for those younger than 2 months, with no significant difference (p = 0.770).
Conclusions:
Despite prior findings that younger age has poor reliability in ETV, the use of ETV and combined ETV/CPC have shown better clinical outcomes than that with ventriculoperitoneal shunting in treating hydrocephalus in this study among African neonates.
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