Endoscopic Third Ventriculostomy With Choroid Plexus Cauterization for the Treatment of Infantile Hydrocephalus in Haiti

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Endoscopic Third Ventriculostomy With Choroid Plexus Cauterization for the Treatment of Infantile Hydrocephalus in Haiti


JournalJournal of neurosurgery pediatrics
Publication date – Jan – 2020
Authors – Ashish H. Shah MD , Yudy LaFortune MD , George M. Ibrahim MD, PhD , Iahn Cajigas MD, PhD , Michael Ragheb MSPH , Stephanie H. Chen MD , Ernest J. Barthélemy MD, MA, MPH , Ariel Henry MD and John Ragheb MD
Keywordscauterization, endoscopic, Haiti, hydrocephalus, ventriculostomy
Open access – Yes
SpecialityNeurosurgery, Paediatric surgery
World region Caribbean
Country: Haiti
Language – English
Submitted to the One Surgery Index on May 7, 2020 at 7:59 am
Abstract:

Objective: Untreated hydrocephalus poses a significant health risk to children in the developing world. In response to this risk, global neurosurgical efforts have increasingly focused on endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) in the management of infantile hydrocephalus in low- and middle-income countries (LMICs). Here, the authors report their experience with ETV/CPC at the Hospital Bernard-Mevs/Project Medishare (HBMPM) in Port-au-Prince, Haiti.

Methods: The authors conducted a retrospective review of a series of consecutive children who had undergone ETV/CPC for hydrocephalus over a 1-year period at HBMPM. The primary outcome of interest was time to ETV/CPC failure. Univariate and multivariate analyses using a Cox proportional hazards regression were performed to identify preoperative factors that were associated with outcomes.

Results: Of the 82 children who underwent ETV/CPC, 52.2% remained shunt free at the last follow-up (mean 6.4 months). On univariate analysis, the ETV success score (ETVSS; p = 0.002), success of the attempted ETV (p = 0.018), and bilateral CPC (p = 0.045) were associated with shunt freedom. In the multivariate models, a lower ETVSS was independently associated with a poor outcome (HR 0.072, 95% CI 0.016-0.32, p < 0.001). Two children (2.4%) died of postoperative seizures.

Conclusions: As in other LMICs, ETV/CPC is an effective treatment for hydrocephalus in children in Haiti, with a low but significant risk profile. Larger multinational prospective databases may further elucidate the ideal candidate for ETV/CPC in resource-poor settings.

OSI Number – 20307
PMID – 31923887

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