Mobile Endoscopy: A Treatment and Training Model for Childhood Hydrocephalus

Qureshi, Mubashir Mahmood; Piquer, José; Young, Paul H.

doi:10.1016/j.wneu.2012.02.001

Cited by 20 publications

(35 citation statements)

References 2 publications

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“…Infection is rife, and the patients are often only brought for care at an advanced stage of ventriculomegaly. 4,[17][18][19]21,22,24,25,29 In the current setting, the effectiveness of ETV was 51%, which is only slightly lower than that reported in other patient series in a similar geographic context. 22,24,25,29 A possible reason for this is that we were unable to perform choroid plexus coagulation, as suggested by Warf et al [22][23][24]27 In addition, we realize that children healthy after ETV may not return for follow-up due to travel and cost limitations.…”

Section: Discussionmentioning

confidence: 68%

“…9 Due to the great number of unforeseen difficulties, both infectious and mechanical, and the absence of neurosurgical care services, this procedure is a safe alternative to high-risk shunt surgery in the context of poverty 18,19 and infection, as well as preventing life-long dependence on a shunt.…”

Section: Discussionmentioning

confidence: 99%

“…Estimates indicate that less than 5% of children with hydrocephalus in Africa receive standard shunt surgery each year; however, due to multiple factors, including infection of permanent implants, the failure rate of shunt surgery performed on the children who actually receive it ranges from 25% to 50%. 14,18,19 Placement of a ventriculoperitoneal shunt creates lifetime dependency. In addition to the need for periodic monitoring, this surgery presents numerous complications such as infections or mechanical malfunctions, and local doctors are often not qualified to find a solution.…”

mentioning

confidence: 99%

“…In selected patients, ETV is the safer option in a limited context such as sub-Saharan Africa. [17][18][19]25 Innovative studies by Warf and others have shown that ETV can improve hydrocephalus in more than 70% of cases, 28 with a low rate of complications (approximately 5%) and a normalizing of CSF dynamics. 2 A mobile neuroendoscopy training program was developed in 2006 by the Neurosurgery Education and Development (NED) Foundation and the Foundation for International Education in Neurological Surgery (FIENS).…”

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confidence: 99%

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Neurosurgery Education and Development program to treat hydrocephalus and to develop neurosurgery in Africa using mobile neuroendoscopic training

Piquer

Qureshi

Young

et al. 2015

PED

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OBJECT A shortage of neurosurgeons and a lack of knowledge of neuroendoscopic management of hydrocephalus limits modern care in sub-Saharan Africa. Hence, a mobile teaching project for endoscopic third ventriculostomy (ETV) procedures and a subsequent program to develop neurosurgery as a permanent specialty in Kenya and Zanzibar were created and sponsored by the Neurosurgery Education and Development (NED) Foundation and the Foundation for International Education in Neurological Surgery. The objective of this work was to evaluate the results of surgical training and medical care in both projects from 2006 to 2013. METHODS Two portable neuroendoscopy systems were purchased and a total of 38 ETV workshops were organized in 21 hospitals in 7 different countries. Additionally, 49 medical expeditions were dispatched to the Coast General Hospital in Mombasa, Kenya, and to the Mnazi Moja Hospital in Zanzibar. RESULTS From the first project, a total of 376 infants with hydrocephalus received surgery. Six-month follow-up was achieved in 22%. In those who received follow-up, ETV efficacy was 51%. The best success rates were achieved with patients 1 year of age or older with aqueductal stenosis (73%). The main causes of hydrocephalus were infection (56%) and spina bifida (23%). The mobile education program interacted with 72 local surgeons and 122 nurses who were trained in ETV procedures. The second project involved 49 volunteer neurosurgeons who performed a total of 360 nonhydrocephalus neurosurgical operations since 2009. Furthermore, an agreement with the local government was signed to create the Mnazi Mmoja NED Institute in Zanzibar. CONCLUSIONS Mobile endoscopic treatment of hydrocephalus in East Africa results in reasonable success rates and has also led to major developments in medicine, particularly in the development of neurosurgery specialty care sites.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Neurosurgery Education and Development program to treat hydrocephalus and to develop neurosurgery in Africa using mobile neuroendoscopic training

Piquer

Qureshi

Young

et al. 2015

PED

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“…Many of the international surgical initiatives for hydrocephalus to date have attempted to address the aforementioned issues by improving the longevity and continuity of local initiatives, providing training for local health professionals and fellowship programs for the next generation of local neurosurgeons, following up with patients, and crafting innovative interventions, such as ETV/CPC, that are ultimately more suitable to a developing nation's scarce resources. 10,11,45,48,62,66,68 …”

Section: Ethics Of International Aidmentioning

confidence: 99%

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

Muir

Wang

Warf

2016

FOC

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OBJECTIVE Pediatric hydrocephalus is one of the most common neurosurgical conditions and is a major contributor to the global burden of surgically treatable diseases. Significant health disparities exist for the treatment of hydrocephalus in developing nations due to a combination of medical, environmental, and socioeconomic factors. This review aims to provide the international neurosurgery community with an overview of the current challenges and future directions of neurosurgical care for children with hydrocephalus in low-income countries. METHODS The authors conducted a literature review around the topic of pediatric hydrocephalus in the context of global surgery, the unique challenges to creating access to care in low-income countries, and current international efforts to address the problem. RESULTS Developing countries face the greatest burden of pediatric hydrocephalus due to high birth rates and greater risk of neonatal infections. This burden is related to more general global health challenges, including malnutrition, infectious diseases, maternal and perinatal risk factors, and education gaps. Unique challenges pertaining to the treatment of hydrocephalus in the developing world include a preponderance of postinfectious hydrocephalus, limited resources, and restricted access to neurosurgical care. In the 21st century, several organizations have established programs that provide hydrocephalus treatment and neurosurgical training in Africa, Central and South America, Haiti, and Southeast Asia. These international efforts have employed various models to achieve the goals of providing safe, sustainable, and cost-effective treatment. CONCLUSIONS Broader commitment from the pediatric neurosurgery community, increased funding, public education, surgeon training, and ongoing surgical innovation will be needed to meaningfully address the global burden of untreated hydrocephalus.