Initial experience with endoscopic third ventriculostomy in Nigeria, West Africa

Abstract

This paper confirms the extremely important potential role that the diffusion of the modern endoscopic third ventriculostomy (ETV) instrumentation and technique might have in the developing world. In fact, though apparently showing nothing particularly new about indications and immediate postoperative results of ETV, the paper should be viewed as the description of a 2-month experience in a West African region with the perspective of 150 ETV procedures/year, a rate that is well above the numbers of most experienced centers of the occidental world. These data are comparable with those published by Warf [1] concerning a pediatric population in an East and Central African population. As this last author has previously underlined, besides the economical costs of a shunt implantation, shunt dependency in emerging countries is more riskful than in developed ones, due to the difficulties in accessing competent intervention in the event of shunt malfunction or infection. Moreover, shunt complications, especially those of infectious origin, surely have a higher incidence in these contexts. Further interesting data from the paper by Idowu et al. when compared with the studies by Warf [1, 2] come from their patients selection, with only obstructive triventricular hydrocephalus and thoughtfully obstructive tetraventricular hydrocephalus patients considered. This factor further highlights the potential of ETV in these regions, where ETV, for the above-mentioned reasons, has been used with encouraging results also in patients with clinical and radiological indications usually not primarily considered in developed countries.