Introduction Pediatric Hydrocephalus is a common disease in sub-Saharan Africa. In Mali, 350-400 new cases are diagnosed in our center yearly. With a total land mass of 1.241.000 km2, patients in remote areas must travel up to 1500km to access neurosurgical care. Hence, treatment and follow-ups of “shunted” patients are difficult. In this context, endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) provides an opportunity for an affordable and less-constraining treatment for hydrocephalus children under 12 months of age. Methods We performed a retrospective analysis of ETV/CPC performed on infants from July 2013 to January 2015. Patients were followed post operatively on Day 15, Month 6 and Month 12. Statistical analysis was conducted using Prism 9 GraphPad software. ETV successes were categorized according to the patient’s age in 03 groups: < 3 months, 3 - 6 months, and 6 - 12 months. Statistical significance was defined at p <0.05. Results During the study period, 199 patients were included with 40% of patients aged between 0-6 months. The head circumference ranged from 35 cm to 79 cm. The etiology was congenital malformation in 55%. ETV/CPC was a success in 69% of 6–12-month-old patients, 54% in the 3–6-month-old patients, and 29% in < 3month-old patients. Overall, 94 (47%) of patients were successfully treated without a shunt. The post-operative infection rate was 1% and mortality at 12 months was 8%. Discussion/Conclusion In a low-income environment such as Mali, ETV/CPC stands as a viable and alternative treatment option for pediatric hydrocephalus patients, our findings suggest that age is an important factor in predicting ETV success.

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