Pediatric Neurosurgery · 6 authors, 3 centres
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This retrospective study from Mali reports that endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) successfully avoided shunt dependence in 47% of infants under 12 months with hydrocephalus. Success rates varied significantly by age: 69% in 6–12 month-olds, 54% in 3–6 month-olds, and 29% in infants ≤3 months. The findings support ETV/CPC as a viable alternative to shunts in low-income settings where follow-up is limited.
**Background:** Pediatric hydrocephalus is a major burden in sub-Saharan Africa, with an estimated incidence of >180,000 infants yearly. In Mali, patients in remote areas must travel up to 1,500 km to access neurosurgical care, making shunt-dependent treatment particularly challenging due to limited follow-up capacity. Endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) offers a shunt-free alternative. Since its introduction in Mali in 2013, no outcome data had been published. This study aimed to report the experience with ETV/CPC in a low-income setting.
**Methods:** A retrospective analysis was conducted of all hydrocephalus infants under 12 months who underwent ETV/CPC at Hopital du Mali in Bamako between July 2013 and January 2015, following the CURE protocol. Patients were followed postoperatively at day 15, month 6, and month 12. Statistical analysis used Prism 9 GraphPad software. ETV successes were categorized into three age groups: ≤3 months, 3–6 months, and 6–12 months. Comparisons between groups used ANOVA followed by Tukey test, with significance defined at p < 0.05.
**Key Results:** A total of 199 patients were included (119 males, 80 females). Age distribution: 80 patients (40%) ≤3 months, 71 (36%) aged 3–6 months, and 48 (24%) aged 6–12 months. Head circumference ranged from 35 cm to 79 cm (mean 42 cm). Etiology was congenital malformation in 55%. Intraoperatively, stigma of infection with anatomical distortion was noted in 103 patients (52%), and scar tissue around the basal cistern was found in 59 patients (32%). In those with cisternal scarring, the failure rate was 80% (47/59). The overall ETV/CPC success rate at 12-month follow-up (including those who required repeat ETV) was 47% (94 patients). Success rates by age group: 69% in 6–12 month-olds (33/48), 54% in 3–6 month-olds (38/71), and 29% in ≤3 month-olds (23/80). One-way ANOVA showed significant differences between groups (F = 4.31, p = 0.0099), with Tukey test confirming a significant difference between group 1 (≤3 months) and group 3 (6–12 months) (p = 0.007). The postoperative infection rate was 1% (2 cases of meningitis). Mortality at 12 months was 8% (16 patients), with causes including severe malaria (6), severe pneumopathy (5), and nonspecific infectious syndrome (5).
**Clinical Implications:** This study demonstrates that ETV/CPC is a viable alternative to shunt placement for infantile hydrocephalus in a low-income country like Mali, where geographical and security constraints limit follow-up. Nearly half of all infants avoided shunt dependence. Age was a significant predictor of success, with the best outcomes in infants aged 6–12 months. The 1% infection rate compares favorably to shunt surgery. The 8% mortality, while higher than in some high-income settings, was not directly attributable to the procedure. The authors note that their overall success rate of 47% was adversely affected by the predominance of the youngest age group and by not shunting patients with cisternal scarring, unlike some prospective protocols. Nonetheless, ETV/CPC reduces the need for implanted shunts and mitigates the dangers of shunt dependence in settings with limited access to emergency neurosurgical care.