Outcome of endoscopic third ventriculostomy and Chhabra shunt system in noncommunicating non-tumor childhood hydrocephalus

Abstract

Background:Endoscopic third ventriculostomy (ETV) the main alternative to ventriculoperitoneal shunt (VPS) is just beginning to have a foothold in West Africa. It provides a great opportunity for a hydrocephalic child to be shunt free. The purpose of this paper is to compare outcome following ETV and VPS (using the cheap Chhabra shunt) in children with noncommunicating non-tumoral hydrocephalus in an environment where late presentation is the norm.Materials and Methods:Sixty-three pediatric patients (< 6 years) with hydrocephalus who underwent a VPS or ETV at our hospital were included in this study. The study period was of 30 months (January 2006 till June 2008). Clinically successful outcome was defined as no event occurring during or after surgery that resulted in an alternate surgical procedure, or significant post-operative complication that includes death. All complications related to the procedures were also analyzed.Results:The outcome of surgical intervention was not significantly related to the gender, age of the patient at surgery, or type of surgery. The post-operative complication rate was similar in both groups.Conclusions:The clinical outcome of ETV is comparable to that of VPS, with the added benefit of no shunt-related problems; and being a short procedure, patient anesthesia and operation time, hospital stay, and cost are significantly reduced. We consider ETV to be the procedure of choice for the treatment of noncommunicating nontumoral hydrocephalus in the pediatric population.

Early outcome of combined endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus

“…Anecdotal evidence suggests a cultural tendency toward attributing the disease to the realm of the supernatural or the superstitious. 6 When accompanied by a less than optimal health care system and a high default rate, traditional treatment options like shunt devices are fraught with many challenges.…”

“…Most of these researchers have used ETV alone as the treatment option. 6,8,10,12,22 One of the authors (O.B.B.) received training in the use of combined ETV+CPC for treating hydrocephalus in 2006.…”

“…17,20 It is therefore expedient to look for a treatment option that is less prone to complications for children in our environment. 6,15,25 Endoscopic third ventriculostomy (ETV) has become abbreviatioNs CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; MM = myelomeningocele; NPIH = non-postinfective hydrocephalus; PIH = postinfective hydrocephalus. submitted May 25, 2014. accePted October 6, 2014. iNclude wheN citiNg Published online February 13, 2015; DOI: 10.3171/2014.10.PEDS14228.…”

“…25 Because of a relatively poor socioeconomic status, most of these children do not always have ready access to specialist care at the onset of the disease and typically can present weeks to months after symptom onset. 6 The use of ventriculoperitoneal shunts, long regarded as standard treatment for hydrocephalus, is confounded in many less-developed nations because of its high complication rate, which is worsened by a health culture that lacks long-term follow-up by both the parents and the health care system. 17,20 It is therefore expedient to look for a treatment option that is less prone to complications for children in our environment.…”

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

“…37 This high burden of disease is coupled with the reality that most families do not have ready access to specialized neurosurgical care, and many cultural and economic factors lead to delayed presentation to medical care, often weeks to months after the symptomatic onset of hydrocephalus. 27,29 Some factors include shame for carrying a sick child, unawareness of treatment, poverty, initial attempt with traditional healing methods, poor understanding of early signs and symptoms, social taboos, or lack of physical access to health care. 34,37,53,57 Limited access to already limited health resources, greater burden of pediatric hydrocephalus, and complex social and geographical barriers pose significant challenges for international global surgery efforts.…”