Abstract
In low-income countries, endoscopic third ventriculostomy (ETV) with or without choroid plexus coagulation (CPC) is an increasingly accepted alternative to shunt therapy in adult and pediatric hydrocephalus. The authors report the result of this treatment in Conakry in a mixed population of adult and pediatric patients regardless of the etiology of the hydrocephalus. A retrospective study was conducted on 76 patients undergoing 89 ETV from January 2013 to September 2020. The predominant group of patients was infants less than one year with a mean age of 4.3 months and extremes of 1 - 8 months. The H/F sex ratio was 1.7/1. All patients presented acutely with signs of high intracranial pressure. Post-infectious causes and malformations and tumors were the main etiologies, respectively 21%, 47.3%, and 15.7%. The mean duration of the endoscopic procedures was 49.93 ± 10.9 mm, associated with a choroid plexus coagulation in 42% of cases. The complication rate in the first month was 22%, with CSF leak (5%) and death (11%) accounting for the majority. At three months, the complications rates were 45%, with 14.4% closed stroma, 6% epilepsy, and 24% mortality. The mean follow-up was 28 months (range 2 - 53), and the global success rate of 61%. Our study, with its limitations, shows that ETV with CPC is a safe primary approach for the treatment of hydrocephalus in low-income countries regardless of the etiology and the age of the patients.
Highlights
Hydrocephalus is the most frequent cause of referral in Pediatric Neurosurgery in Guinea, and most cases of hydrocephalus in children are congenital or acquired during the early childhood period [1]
Endoscopic third ventriculostomy (ETV) has recently emerged as a good alternative for obstructive hydrocephalus in most neurosurgical services, with reasonable success rates published in the literature worldwide in adults [3] and infants older than one year regardless of the etiology of the obstructive hydrocephalus [4]
All patients operated by Endoscopic Third Ventriculostomy (ETV) with or without Choroid Plexus Coagulation (CPC) were included for this study
Summary
Hydrocephalus is the most frequent cause of referral in Pediatric Neurosurgery in Guinea, and most cases of hydrocephalus in children are congenital or acquired during the early childhood period [1]. In Guinea, we adopted ETV with or without choroid plexus coagulation (CPC) since 2012 as a 1st attempt when technically feasible in all cases of hydrocephalus regardless of age and etiology. This approach aimed to reduce CSF shunt dependency and improve clinical outcomes. We, felt it appropriate, after nine years, to highlight the experience of our department in the practice of this endoscopic technique in the present study
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