Role of the Pediatric Neurosurgeon in the Management of Hydrocephalus Internationally

Abstract

The recent emphasis on surgery as an essential yet neglected component of global health care has drawn attention to the lack of pediatric neurosurgery in low- and middle-income countries (LMICs). Most LMICs have very few neurosurgeons able or willing to care for children, leaving few access to care for readily treatable conditions, like pediatric hydrocephalus and spina bifida. Herein, we review the role of pediatric neurosurgeons to improve hydrocephalus management and medical education in LMICs. A literature search on global pediatric neurosurgery was performed using the Pubmed database from the year 2000 to October 5th, 2021. The majority of current pediatric neurosurgical efforts focus on the management of hydrocephalus. Endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC) has emerged as an effective alternative to ventriculoperitoneal (VP) shunting for CSF diversion in LMICs. Neurosurgical programs in LMICs are most successful when twinning is used to pair the program with an established center in a high-income country (HIC). Multiple international pediatric neurosurgical efforts aim to provide medical expertise, infrastructure, and surgical education to LMICs. The next step in developing sustainable surgery programs in LMICs includes establishing local training programs. Existing global pediatric neurosurgery programs are most successful when partnered to an experienced center in a HIC. A lack of funding, resources, and training programs all pose barriers to increasing the pediatric neurosurgical capacity in LMICs. Future global neurosurgery efforts may look to other neurosurgical conditions with high burdens of disease in LMICs, like epilepsy.

Understanding and Modeling the Pathophysiology of Hydrocephalus: In Search of Better Treatment Options

“…Hydrocephalus can also be treated by ablating the choroid plexus (CP) in the ventricles of the brain. This technique is not used as frequently in developed countries, but it is used often in less developed countries because it avoids the cost of shunt hardware and patient shunt dependency [32,33]. Additionally, there is a lack of pediatric neurosurgery training programs in developing countries [32].…”

“…This technique is not used as frequently in developed countries, but it is used often in less developed countries because it avoids the cost of shunt hardware and patient shunt dependency [32,33]. Additionally, there is a lack of pediatric neurosurgery training programs in developing countries [32]. Choroid plexus cauterization (CPC) is commonly paired with ETV.…”

“…Ventriculoperitoneal shunts Possibility of infection [32][33][34] There have been past attempts to use nonsurgical hydrocephalus treatments. Osmotic diuretics were one such treatment.…”