Pediatric Hydrocephalus in Northwest Tanzania: A Descriptive Cross-Sectional Study of Clinical Characteristics and Early Surgical Outcomes from the Bugando Medical Centre

Aukrust, Mphil Camilla G.; Parikh, Karishma; Smart, Luke R.; Mdala, Ibrahimu; Fjeld, Heidi; Lubuulwa, James; Makene, Antonia Msafiri; Härtl, Roger; Winkler, Andrea Sylvia

doi:10.1016/j.wneu.2022.02.003

Cited by 6 publications

(3 citation statements)

References 32 publications

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“…Early diagnosis of secondary hydrocephalus is of great significance to guide clinical treatment and improve the prognosis of patients [ 5 , 6 ]. We used to rely on typical symptoms and signs and imaging examination to distinguish between hemorrhagic hydrocephalus and neoplastic hydrocephalus [ 7 , 8 ]. However, some patients may have no specific symptoms and signs, and the imaging changes are often not obvious, which leads to the difficulty of clinical diagnosis and treatment [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Value of CSF‐Cl, CSF‐GS, CSF‐MALB, and CSF‐ADA in Differential Diagnosis of Secondary Hydrocephalus

Huang

Chen

2022

Contrast Media & Molecular Imaging

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Objectives. To investigate the value of cerebrospinal fluid chloride (CSF-Cl), cerebrospinal fluid glucose (CSF-GS), cerebrospinal fluid microalbumin (CSF-MALB), and cerebrospinal fluid adenosine deaminase (CSF-ADA) in the differential diagnosis of secondary hydrocephalus. Methods. 103 patients with secondary hydrocephalus treated in our hospital from January 2018 to April 2022 were selected. According to different types, it is divided into the hemorrhagic hydrocephalus group and tumor hydrocephalus group. By detecting the levels of inflammatory factors such as CSF-Cl, CSF-GS, CSF-MALB, and CSF-ADA in the two groups, we can analyze the value of these inflammatory factors in the differential diagnosis of secondary hydrocephalus. Results. The level of CSF-MALB in the hemorrhagic hydrocephalus group was significantly higher than that in the tumor hydrocephalus group, and the difference between the two groups was statistically significant ( P < 0.05 ). There was no significant difference in the levels of CSF-Cl, CSF-GS, and CSF-ADA between the two groups ( P > 0.05 ). The area under ROC curve (AUC) of CSF-Cl, CSF-GS, CSF-MALB, and CSF-ADA in the differential diagnosis of secondary hydrocephalus was 0.438, 0.553, 0.750, and 0.542, respectively, sensitivity was 15.1%, 45.3%, 79.2%, and 18.9%, respectively, and specificity was 96.0%, 80.0%, 80.0%, and 94.0%, respectively. Conclusions. The inflammatory reaction of hemorrhagic hydrocephalus was significantly greater than that of tumor hydrocephalus. Moreover, CSF-MALB is closely related to the pathogenesis of hemorrhagic hydrocephalus. At the same time, CSF-MALB can be used as a good index for rapid differential diagnosis of secondary hydrocephalus.

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Section: Introductionmentioning

confidence: 99%

[Retracted] Value of CSF‐Cl, CSF‐GS, CSF‐MALB, and CSF‐ADA in Differential Diagnosis of Secondary Hydrocephalus

Huang

Chen

2022

Contrast Media & Molecular Imaging

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“…We determined that 1 in 5 Filipinos did not have access to a full-time neurosurgeon, and this puts patients requiring neurosurgery at risk for poorer outcomes. 28,29 Consider, for example, a child with an expanding extradural hematoma from the island province Romblon (total population: 308 985; number of neurosurgeons: 0). This patient would have to travel by land and sea to get to the nearest province with a full-time neurosurgeon, Batangas (total population: 2 908 494; number of neurosurgeons: 7).…”

Section: Discussionmentioning

confidence: 99%

The Neurosurgical Workforce of the Philippines

Baticulon,

Lucena,

Gimenez

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: No study has comprehensively examined the delivery of neurosurgical care in the Philippines, a lower-middle–income country in Southeast Asia with a total population of 109 million. We aimed to quantify the workforce, map the distribution, and characterize the clinical practice of neurosurgeons across the 17 regions and 81 provinces of the Philippines. METHODS: An online survey was sent to all fellows of the Academy of Filipino Neurosurgeons and all graduates of neurosurgical training programs in the country. Neurosurgeons who have been in active clinical practice for at least 1 year were eligible to participate. A database of Filipino neurosurgeons was generated through personal communications, correspondence with neurosurgery departments, and accessing publicly available information. The top neurosurgical procedures were identified to estimate the overall volume of neurosurgical disease. RESULTS: There are 174 neurosurgeons practicing in the Philippines or approximately one neurosurgeon for every 600 000 people. In 9 provinces, neurosurgeons were only available part-time, and 35 provinces had no neurosurgeons at all, equivalent to an underserved population of 24 million people. Among 99 survey respondents, the median numbers of neurosurgical consults and operations every month were 30 (IQR:35) and 8 (IQR:8), respectively. The top neurosurgical procedures were burr holes/craniotomy for traumatic brain injury, craniotomy for stroke, and biopsy/resection of brain tumors. There are an estimated 93 498 cases requiring essential neurosurgery every year. CONCLUSION: Although positive trends have been observed in the number, distribution, and composition of neurosurgeons in the Philippines, there remains a large workforce deficit that needs to be addressed to provide timely, quality, and affordable neurosurgical care to the entire population.

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“…It develops from an abnormal buildup of CSF in the ventricles as a result of a disruption of CSF ow from the site of secretion to absorption. The clinical presentations of patients with hydrocephalus vary with age (1)(2)(3). The treatment routine of managing patients with hydrocephalus by the placement of VPS is an entrenched modality, especially in areas with limited workforce and resources (4,5).…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Causes and Early Outcomes of Shunt Revisions at a Tertiary Hospital in Tanzania

Machaku,

Rabiel,

Chilonga

2023

Preprint

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BACKGROUND The mainstay treatment for patients presenting with hydrocephalus is surgical, with VPS placement being a routine practice, especially in hospitals with limited resources and workforce. Nonetheless, avoidable complications following VPS placements are still evident compounding to significant patient morbidity and mortality.METHODS This study was carried out at a tertiary hospital between March 2020 and March 2023. It includes 263 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-up care for three months, at which time their characteristics in relation to shunt complications were evaluated. The SPSS version 26 was utilized for analyzing the data that had been gathered.RESULTS VPS revisions were performed on 90 of 263 patients, a prevalence of 34.2%. The majority (92.2%) were pediatric patients. Females made up 52.2% of the patients. The most common reason for revisions was shunt infection (50%), followed by malposition (27.8%), blockage (15.6%), and shunt dislocation (6.7%). SSI increased the likelihood of shunt revision by 29.8%. Shunt revision was 31% more likely in operations lasting longer than 45 minutes. Intraoperative involvement of a junior surgical trainee raised the possibility of revision by 25%, and a revised VPS system is 13.2 times more likely to fail, integrating to longer hospital stays.CONCLUSION The emphasis on long surgery durations and a surgeon's skill as risk factors for revisions demonstrates a need for change in surgical practice to enhance surgical outcomes. Given the high likelihood of re-revisions after VPS revisions, it is suggested that the surgical practice from the index operation be enhanced to reduce complications. The findings of this study might serve as an initial guide for developing interventional techniques to enhance good surgical outcomes.

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Pediatric Hydrocephalus in Northwest Tanzania: A Descriptive Cross-Sectional Study of Clinical Characteristics and Early Surgical Outcomes from the Bugando Medical Centre

Cited by 6 publications

References 32 publications

[Retracted] Value of CSF‐Cl, CSF‐GS, CSF‐MALB, and CSF‐ADA in Differential Diagnosis of Secondary Hydrocephalus

[Retracted] Value of CSF‐Cl, CSF‐GS, CSF‐MALB, and CSF‐ADA in Differential Diagnosis of Secondary Hydrocephalus

The Neurosurgical Workforce of the Philippines

Prevalence, Causes and Early Outcomes of Shunt Revisions at a Tertiary Hospital in Tanzania

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