Intraoperative Findings During Neuro-Endoscopy for Hydrocephalus in Tanzania

Authors

  • Duncan Bruce Henderson Sheffield Children's Hospital
  • Laurence Lemery Muhimbili Orthopaedic Institute
  • Aingaya Kaale Muhimbili Orthopaedic Institute
  • Japhet Ngerageza Muhimbili Orthopaedic Institute
  • Alpha Kinghomella Muhimbili Orthopaedic Institute
  • Hamisi Shabani Muhimbili Orthopaedic Institute

DOI:

https://doi.org/10.51437/jgns.v4i1.337

Keywords:

Endoscopic third ventriculostomy, Choroid plexus cauterization, aqueductal stenosis, hydrocephalus, post-infectious hydrocephalus

Abstract

Background: Endoscopic third ventriculostomy (ETV) can be performed to treat infantile hydrocephalus with variable success.

Methods: We included patients undergoing ETV+/-Choroid plexus cauterization (CPC) in Dar Es Salaam, Tanzania from November 2011-February 2019. Prospective data collection was carried out by the chief surgeon with a total sample size of 497. A separate database from the hydrocephalus nurse provided one-year mortality outcomes from January 2017-December 2018 in 261 patients.

Results: The median age was 138 days; 6%<1 month, 57% were 1-6 months and 20% were 6-12 months old. The median occipitofrontal circumferences were: 50cm (age<1 month old); 49cm (1-6 months old); 55cm (6-12 months old). Cortical mantle was thin in 73% and normal in 27%. The aqueduct of sylvius was visualised and closed in 61% and open in 33%. Yellow deposits were seen in 40% and pus in 3%. The CSF was turbid, bloodstained, yellow and clear in 16%, 1%, 3% and 80% respectively. The prepontine cistern was clear in 73%, scarred in 12%, effaced in 11% and not seen in 4%. The tuber cinereum was thin in 85%, thick in 11% and not fenestrated 4%. The choroid plexus was normal in 65% and scarred in 35%. Clinical follow up at 1-month post op was available in 123 (<25%) patients. At 1-month postop the mortality, re-do ETV and VP shunt insertion rates were 8%, 6% and 8% respectively. From the nurse led database, the one-year overall survival was 87%.

Conclusion: ETV+/-CPC is an established treatment option for infantile hydrocephalus in Tanzania.

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Published

2024-07-09