Hydrocephalus In Infants Research Articles

Postmeningeal Hydrocephalus in Infants: A Case Report of 39 Patients

Aim and Objective: This study aimed to report on the management of post-meningeal hydrocephalus in infants at our centre. Methods: This was an observational, descriptive, cross-sectional study of 39 cases of postmeningeal hydrocephalus operated on in infants. Results: The mean age of the infants was 8.64 months. Clinical signs were dominated by macrocrania in all patients. FET and CT were the most frequently requested morphological examinations for diagnosis, and few patients were able to benefit from CT (41%). In 69% of cases, hydrocephalus occurred within 2 months of the onset of meningitis. Treatment consisted of antibiotic therapy until the CSF was sterilised, followed by the installation of a shunt system. The mortality rate was 8%. Conclusion: This study highlights the need for prevention and appropriate treatment of meningitis, early detection of hydrocephalus and the effectiveness of ventriculoperitoneal shunting in the treatment of hydrocephalus.

Fibrinolytic (Thrombolytic) Therapy for Post Intraventricular Hemorrhagic Hydrocephalus in Preterm Infants.

While the survival rate of preterm infants has increased dramatically over the last few decades, intraventricular hemorrhage and subsequent hydrocephalus remain major unsolved problems in neonatal intensive care. Once intraventricular hemorrhage occurs, severe neurological sequelae are inevitable. Treatment of this complicated pathology and achievement of favorable neurofunctional outcomes in fragile infants are crucial challenges for pediatric neurosurgeons. Fibrinolytic therapy, which chemically dissolves hematoma, is a promising and useful treatment method. In this paper, the historical background of fibrinolytic therapy for postintraventricular hemorrhagic hydrocephalus in preterm infants is reviewed and a recent method of fibrinolytic therapy using urokinase is introduced.

Management of ventriculoperitoneal shunt complications in children: A review of 34 cases.

The primary objective of this study was to analyse the demographics of the children who presented with ventriculoperitoneal shunt (VPS) complications. The secondary objectives were to review the clinical characteristics, surgical procedures performed for the management of VPS complications and the final outcome. This is a single-institution observational study that included children below 12 years of age who required VPS revisions during the study period. During the study period of 10 years, n = 336 VPS catheters were implanted for the treatment of hydrocephalus in children. Forty (11.90%) children developed various VPS complications and required VPS revisions in the follow-up period. A total of n = 30 (8.92%) children (n = 21 boys and n = 9 girls) were selected/recruited for the present study, and they required n = 34 revision procedures. The mean interval from VPS insertion to the diagnosis of the complication was 7.29 months. VPS complications that required revisions occurred in the following order of frequency: (1) VPS catheter, cerebrospinal fluid (CSF) or shunt tract infection n = 8 (2.38%); (2) malfunction of distal VPS catheter n = 7 (2.08%); (3) coiling of distal VPS catheter at abdominal area n = 6 (1.78%); (4) extrusion of VPS catheter n = 5 (1.48%); (5) CSF leak from abdominal wound site/umbilicus n = 4 (1.19%); (6) malfunction of ventricular catheter n = 3 (0.89%) and (7) CSF pseudocyst peritoneal cavity n = 1 (0.29%). Surgical procedures were performed for the treatment of abovementioned complications in the following order of frequency: (1) revision of distal VPS catheter n = 14 (4.16%), (2) removal of entire VPS catheter ± external ventricular drainage (EVD) n = 7 (2.08%), (3) distal VPS catheter converted as EVD n = 6 (1.78%), (4) revision of proximal VPS catheter n = 3 (0.89%), (5) revision of entire VPS catheter n = 3 (0.89%) and (6) CSF pseudocyst excision n = 1 (0.29%). This study also documented n = 2 (6.6%) deaths during the post-operative period. VPS insertion done for the treatment of hydrocephalus in infants and children was associated with various complications. Seventy per cent of the complications occurred within the first 6 months after the VPS insertion. Two-thirds of the complications were related to the distal VPS catheter.

Редкий клинический случай: синдром мегалоэнцефалии – постаксиальной полидактилии – полимикрогирии – гидроцефалии

We report an exceedingly rare case of megalencephaly, postaxial polydactyly, polymicrogyria, and hydrocephalus in a 9-monthold infant. The information in the article will help doctors to perform adequate differential diagnostic search in time. We describe the history of this syndrome discovery and provide a detailed description of the results of magnetic resonance imaging Key words: congenital abnormalities of the central nervous system, hydrocephalus, megalencephaly, perinatal diagnosis, fetus, polymicrogyria, postaxial polydactyly

Postinfectious hydrocephalus in African infants: common, under-recognised, devastating, and potentially preventable

With an almost 200 000 estimated new cases of infant hydrocephalus annually, this disease constitutes a heavy burden of disease in sub-Saharan Africa.1 A 2011 analysis estimated that untreated infant hydrocephalus in these countries could result in annual economic losses of more than US$50 billion.2 Currently, the only available treatments for infant hydrocephalus require neurosurgical intervention, to which there is very poor access across Africa. This means that many, and perhaps most, of these infants are never treated, resulting in unnecessary suffering, disability, and death.

The Λ-Fractional Hydrocephalus Model

Infant hydrocephalus is a clinically abnormal clinical state with an accumulation of fluid in cavities (ventricles) deep within the brain. Hence, pressure is increased inside the skull. The ventricles widen due to the excess fluid applying pressure upon the (parenchyma) brain tissues. The infant brain tissue is described by a biomechanics model as a hyperelastic, Λ-fractional viscoelastic material, trying to describe the various conditions developing hydrocephalus. Λ-fractional continuum mechanics is applied with time variables due to viscosity and space fractional variables due to porosity. The simultaneous influence of both the viscosity and porosity of the membrane material (parenchyma) increases the cerebrospinal fluid’s pressure, causing the fluid’s accumulation in the brain.

Challenges in the pre- and post-natal diagnosis of posterior fossa cysts: A case report and review of historical evolution of descriptive terminologies.

Radiological diagnoses of posterior fossa cystic abnormalities during antenatal and postnatal periods pose significant challenges as they may have similar early imaging features. Some of the frequently described entities are arachnoid cysts and Dandy-Walker malformations. Blake's pouch cyst is relatively underdiagnosed. The main aim of the study was to explore these diagnostic challenges in the context of various descriptive terminologies and their prognostic implications. We illustrate this through our case, where fetal magnetic resonance imaging (MRI) at 36 weeks gestation showed small right cerebellum without hydrocephalus or hemorrhage. Possible differential diagnoses included Dandy-Walker malformation or posterior fossa malformations, facial hemangiomas, arterial anomalies, cardiac and eye anomalies, sternal clefting, and supraumbilical raphe. Postnatal sonography noted posterior fossa cyst without hydrocephalus in a normal term infant, who went on to develop symptomatic hydrocephalus by 15 weeks. Computed tomography brain scan confirmed large subtentorial posterior fossa cyst and extensive internal hydrocephalus. Despite emergent ventriculoperitoneal shunt insertion, head circumference continued to rise. MRI scan showed persistent cyst. Subsequently, infant underwent endoscopic fenestration of the cyst with balloon septostomy and now has an age appropriate developmental profile. There is considerable discordance between antenatal and postnatal neuroimaging findings as highlighted in our case. Diagnostic conundrum here was whether this was an arachnoid or Blake's pouch cyst. Differentiating between posterior fossa fluid collections is crucial for management, prognosis, and parental counseling. Close postnatal follow-up is essential to avert complications due to acute hydrocephalus.

Subcapsular hepatic pseudocyst as a rare complication of ventriculoperitoneal shunt: A case report

Abdominal pseudocysts are an uncommon complication of ventriculoperitoneal shunt (VPS) placement. Patients may be asymptomatic, or present with symptoms such as abdominal pain, abdominal distension, fever, or vomiting. A 13-year-old girl presented to the emergency department complaining of abdominal pain for one week, with a history of VPS insertion for treatment of hydrocephalus in infancy. Diagnosis of an abdominal pseudocyst was made based on abdominal imaging, demonstrating a hepatic cerebrospinal fluid (CSF) pseudocyst free from infection. The patient was managed with aspiration of the CSF pseudocyst, and no intervention was performed on the VPS as the collection was near the distal catheter of the VPS, there were no signs of high intracranial pressure, and the VPS was in a good position. Hepatic pseudocyst is a rare complication of VPS, and can be challenging to diagnose as the primary symptom, acute abdominal pain, is non-specific. Hepatic pseudocyst should be considered when evaluating patients with VPS presenting with abdominal pain.

Treatment Strategies and Challenges to Avoid Cerebrospinal Fluid Shunting for Pediatric Hydrocephalus

Treatment for pediatric hydrocephalus aims not only to shrink the enlarged ventricle morphologically but also to create an intracranial environment that provides the best neurocognitive development and to deal with various treatment-related problems over a long period of time. Although the primary diseases that cause hydrocephalus are diverse, the ventricular peritoneal shunt has been introduced as the standard treatment for several decades. Nevertheless, complications such as shunt infection and shunt malfunction are unavoidable; the prognosis of neurological function is severely affected by such factors, especially in newborns and infants. In recent years, treatment concepts have been attempted to avoid shunting, mainly in the context of pediatric cases. In this review, the current role of neuroendoscopic third ventriculostomy for noncommunicating hydrocephalus is discussed and a new therapeutic concept for post intraventricular hemorrhagic hydrocephalus in preterm infants is documented. To avoid shunt placement and achieve good neurodevelopmental outcomes for pediatric hydrocephalus, treatment modalities must be developed.

This issue of ACTA

This issue of ACTA

Outcomes of Endoscopic Third Ventriculostomy in Pediatric Patients With Hydrocephalus.

BackgroundEndoscopic third ventriculostomy (ETV) is used to treat patients with obstructive hydrocephalus in infants. This study evaluated the postoperative outcomes of ETV among pediatric patients.MethodologyA retrospective study was undertaken at the Mardan Medical Complex between June 2018 and June 2021. All pediatric patients who underwent the procedure of ETV in both the absence and presence of choroid plexus cauterization (CPC) at our center were included in the study. Using medical history data, a comprehensive survey questionnaire was designed. The findings and effects were evaluated either as a success or failure.ResultsA total of 90 cases were reviewed during the study. The rate of in-hospital mortality was 1.1% while the most commonly identified causes of hydrocephalus were myelomeningocele and aqueductal stenosis. A total of 39 (43.33%) patients had a successful surgery. In patients where hydrocephalus was secondary to aqueductal stenosis, the success rate was the highest, while the success rate was quite low for post-infectious hydrocephalus and intraventricular hemorrhage (p < 0.0001). The postoperative complication rate was 55.56% in our study. The rate of in-hospital mortality was 1.1%.ConclusionsWe found that the success rate of ETV was dependent upon factors such as the cause of hydrocephalus, type of hydrocephalus, and the age of the patient. Therefore, ETV is not suitable for all patients, and vigilance must be undertaken in selecting patients for the procedure. The rate of postoperative infections in our institution was alarmingly high which is a concerning matter for the institution.

Clinical outcomes in pediatric hydrocephalus patients treated with endoscopic third ventriculostomy and choroid plexus cauterization: a systematic review and meta-analysis.

Endoscopic third ventriculostomy and choroid plexus cauterization (ETV+CPC) is a novel procedure for infant hydrocephalus that was developed in sub-Saharan Africa to mitigate the risks associated with permanent implanted shunt hardware. This study summarizes the hydrocephalus literature surrounding the ETV+CPC intraoperative abandonment rate, perioperative mortality rate, cerebrospinal fluid infection rate, and failure rate. This systematic review and meta-analysis followed a prespecified protocol and abides by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy using MEDLINE, EMBASE, PsychInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from database inception to October 2019. Studies included controlled trials, cohort studies, and case-control studies of patients with hydrocephalus younger than 18 years of age treated with ETV+CPC. Pooled estimates were calculated using DerSimonian and Laird random-effects modeling, and the significance of subgroup analyses was tested using meta-regression. The quality of the pooled outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. After screening and reviewing 12,321 citations, the authors found 16 articles that met the inclusion criteria. The pooled estimate for the ETV+CPC failure rate was 0.44 (95% CI 0.37-0.51). Subgroup analysis by geographic income level showed statistical significance (p < 0.01), with lower-middle-income countries having a lower failure rate (0.32, 95% CI 0.28-0.36) than high-income countries (0.53, 95% CI 0.47-0.60). No difference in failure rate was found between hydrocephalus etiology (p = 0.09) or definition of failure (p = 0.24). The pooled estimate for perioperative mortality rate (n = 7 studies) was 0.001 (95% CI 0.00-0.004), the intraoperative abandonment rate (n = 5 studies) was 0.04 (95% CI 0.01-0.08), and the postoperative CSF infection rate (n = 5 studies) was 0.0004 (95% CI 0.00-0.003). All pooled outcomes were found to be low-quality evidence. This systematic review and meta-analysis provides the most comprehensive pooled estimate for the ETV+CPC failure rate to date and demonstrates, for the first time, a statistically significant difference in failure rate by geographic income level. It also provides the first reported pooled estimates for the risk of ETV+CPC perioperative mortality, intraoperative abandonment, and CSF infection. The low quality of this evidence highlights the need for further research to improve the understanding of these critical clinical outcomes and their relevant explanatory variables and thus to appreciate which patients may benefit most from an ETV+CPC. Systematic review registration no.: CRD42020160149 (https://www.crd.york.ac.uk/prospero/).

Antibiotic-impregnated external ventricular drainage for the management of post-hemorrhagic hydrocephalus in low birth weight premature infants following intraventricular hemorrhage.

This study aims to evaluate the infection rates and catheterization duration of applying antibiotic-impregnated external ventricular drain (EVD) for the treatment of post-hemorrhagic hydrocephalus (PHH) in low birth weight infants (LBWI). This retrospective cohort study included 13 preterm LBWI with PHH. Data were collected from the patient's medical charts and included gender, gestational age, birth weight, intraventricular hemorrhage grade, ventriculostomy-associated infection (VAI), and the duration of catheterization. All patients were followed up for at least 6months after EVD surgery. The mean gestational age at birth was 27 ± 2.5weeks, and the mean birth weight was 907 ± 220g. Among all patients with IVH, two (6.7%) had grade 2 IVH, five (38.5%) had grade 3 IVH, and six (46.2%) had grade 4 IVH. EVD surgery was conducted once for six patients, twice for five patients, and three times for two patients. One patient (7.7%) had VAI post-EVD surgery at 14days. Three patients (23%) expired due to sepsis, shock, and chylous ascites. Seven patients (53.8%) had hydrocephalus and needed a ventriculoperitoneal shunt over the following course. The longest EVD catheterization period was 57days without sustained VAI. Antibiotic-impregnated EVD has a similar infection rate with the ventricular access device and ventriculosubgaleal shunt. The risk of VAI was not increased even with the EVD catheterization day approaching 2months. Our study supports the evidence that antibiotic-impregnated EVD is safe and effective for the management of PHH in LBWI. However, this research has a small sample sized and a retrospective design.

Thinner peripapillary retinal nerve fibre layer and macular retinal thickness in adolescents with surgically treated hydrocephalus in infancy.

To map the morphology of the retina and optic disc in adolescents with surgically treated hydrocephalus (HC) in infancy and to compare the results with healthy controls. The study comprised 26 adolescents (16 male, mean age 15 years) with HC and 31 sex- and aged-matched controls. The following optical coherence tomography (OCT) parameters were obtained: macular retinal thickness (MRT) and volume (MRV), thickness of the macular and peripapillary retinal nerve fibre layer (ppRNFL), and area of the optic disc, cup and rim. The MRT was thinner amongst those with HC compared with controls (right eye (RE) 262.2 ± 15.3 and 275.8 ± 15.1 μm; p = 0.0051), and the MRV was smaller (RE 7.37 ± 0.36 and 7.83 ± 0.35 mm3 ; p = 0.0002). The HC group showed a thinner ppRNFL (RE 88.3 ± 14.9 and 103.5 ± 8.1 μm; p = 0.0002) but a thicker central macular RNFL (RE 11.6 ± 10.4 and 2.07 ± 3.00 μm; p = <0.0001) and foveal minimum (RE 211.1 ± 32.0 and 186.3 ± 15.9 μm; p = 0.0013). Optic disc variables showed no difference between groups. Correlations were found in the HC group between best corrected visual acuity (expressed in logMAR) and ppRNFL (RE r = -0.56, p = 0.018), and disc area (RE r = -0.52, p = 0.033). Thinner ppRNFL and MRT and smaller MRV were found in adolescents with surgically treated HC in infancy compared with controls. In contrast, the central macular RNFL and foveal minimum were thicker. Further studies are required to evaluate the diagnostic value of OCT to indicate increased intracranial pressure timely and follow-up in individuals with surgically treated HC.

Management of Infected Hydrocephalus in Infancy; Repeated Tapping versus External Ventricular Drain

Background: Infected hydrocephalus is are the most frequent consequences in ventriculoperitoneal shunt patient. Most of the patient treated by external ventricular drain under antibiotic cover. Aim of study: To assess the advantage of ventricular tap compared to external ventricular drain in treating infected hydrocephalus patients in infancy. Patient and methods: A clinical prospective study of 40 patients with infected hydrocephalus collected over one and a half year (2015-2016) in Al-Shahid Ghazi Al-Hariri hospital, medical city, Baghdad. After thorough general and neurological examination, patent was divided in two groups. One treated by external ventricular drain and the other treated by ventricular tap. Both groups were under antibiotic cover. Results: The male: female ratio is1.7, the age’s mean of the study group is 90.4 days. The most frequent cause of hydrocephalus in the study group is congenital hydrocephalus 62.5%. Post meningitis is 32.5% .IVH is 5% .37.5% is associated with myelomeningeocele as associated congenital anomalies. Clear CSF was found in 15% EVD patients, and 89% in ventricular tap patients. The mortality rate is 5% in the EVD, with no death in the ventricular tap patients. Conclusion: Ventricular tap is better in treating patient with infected hydrocephalus than external ventricular drain. EVD group require longer hospital stay along with longer antibiotic cover with lower cure rate and higher mortality compared to the ventricular tap.

EP145: Severe Pierre Robin sequence and hydrocephalus in infant with TUBB3 variant

Pathogenic variants in TUBB3 are associated with congenital fibrosis of the extraocular muscles 3 (CFEOM3) and cortical dysplasia, complex, with other brain malformations 1 (CDCBM1). CDCBM1 is considered a tubulinopathy. Tubulinopathies are a group of conditions that include a large spectrum of brain malformations that are caused by pathogenic variants in genes encoding different tubulin isotypes. There are at least nine different alpha and ß tubulin isotypes, which are closely related subunits that are major components of microtubules (MTs).

Ventriculomegaly thresholds for prediction of symptomatic post-hemorrhagic ventricular dilatation in preterm infants.

Benefits from early surgical intervention in preterm infants with intraventricular hemorrhage (IVH) prior to symptomatic ventriculomegaly must be weighed against risks of surgery. We calculated thresholds of common ventriculomegaly indices at a late-intervention institution to predict subsequent symptomatic ventriculomegaly requiring neurosurgery. We retrospectively reviewed neuroimaging and neurosurgical outcomes in preterm infants with grade III/IV IVH between 2007 and 2020. Frontal-occipital horn ratio (FOHR), frontal-temporal horn ratio (FTHR), anterior horn width (AHW), and ventricular index (VI) were measured. Area under the receiver operating curve (AUC) for predicting intervention (initiated after progressive symptomatic ventriculomegaly) was calculated for diagnostic scan, scans during weeks 1-4, and maximum measurement prior to intervention. Threshold values that optimized sensitivity and specificity were derived. A total of 1254 scans in 132 patients were measured. In all, 37 patients had a neurosurgical intervention. All indices differed between those with and without intervention from the first diagnostic scan (p < 0.001). AUC of maximum measurement was 97.1% (95% CI 94.6-99.7) for FOHR, 97.7% (95% CI 95.6-99.8) for FTHR, 96.6% (95% CI 93.9-99.4) for AHW, and 96.8% (95% CI 94.0-99.5) for VI. Calculated thresholds were FOHR 0.66, FTHR 0.62, AHW 15.5 mm, and VI 8.4 mm > p97 (sensitivities >86.8%, specificities >90.1%). Ventriculomegaly indices were greater for patients who developed progressive persistent ventriculomegaly from the first diagnostic scan and predicted neurosurgical intervention. We derived thresholds of common ventriculomegaly indices (ventricular index, anterior frontal horn width, fronto-occipital horn and fronto-temporal horn index) to best predict the development of progressive symptomatic post-hemorrhage hydrocephalus in preterm infants with intraventricular hemorrhage. While current thresholds were established by a priori expert consensus, we report the first data-driven derivation of ventriculomegaly thresholds across all indices for the prediction of symptomatic hydrocephalus. Data-derived thresholds will more precisely weigh the risks and benefits of early intervention.

Improving Infant Hydrocephalus Outcomes in Uganda: A Longitudinal Prospective Study Protocol for Predicting Developmental Outcomes and Identifying Patients at Risk for Early Treatment Failure after ETV/CPC.

Infant hydrocephalus poses a severe global health burden; 80% of cases occur in the developing world where patients have limited access to neurosurgical care. Surgical treatment combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC), first practiced at CURE Children’s Hospital of Uganda (CCHU), is as effective as standard ventriculoperitoneal shunt (VPS) placement while requiring fewer resources and less post-operative care. Although treatment focuses on controlling ventricle size, this has little association with treatment failure or long-term outcome. This study aims to monitor the progression of hydrocephalus and treatment response, and investigate the association between cerebral physiology, brain growth, and neurodevelopmental outcomes following surgery. We will enroll 300 infants admitted to CCHU for treatment. All patients will receive pre/post-operative measurements of cerebral tissue oxygenation (SO2), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2) using frequency-domain near-infrared combined with diffuse correlation spectroscopies (FDNIRS-DCS). Infants will also receive brain imaging, to monitor tissue/ventricle volume, and neurodevelopmental assessments until two years of age. This study will provide a foundation for implementing cerebral physiological monitoring to establish evidence-based guidelines for hydrocephalus treatment. This paper outlines the protocol, clinical workflow, data management, and analysis plan of this international, multi-center trial.

Infant hydrocephalus: what valve should be used first? Analysis of the BASICS trial, institutional cohort study and literature review

Infant hydrocephalus: what valve should be used first? Analysis of the BASICS trial, institutional cohort study and literature review

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt for treatment of hydrocephalus in infants in a tribal population in India

Study design: Prospective long term follow-up study Background: Hydrocephalus remains a common cause of admission in pediatric neurosurgery units. Of the two prevalent modalities of treatment for hydrocephalus in infants, i.e. endoscopic third ventriculostomy and ventriculoperitoneal shunt, which one is a better option, especially in a tribal setting, is a matter of debate. Aim: To determine and compare the effectiveness of endoscopic third ventriculostomy versus ventriculoperitoneal shunt for the treatment of infants in a tribal population. Methods: A prospective follow-up study was carried out on 70 patients of hydrocephalus with age less than or equal to 12 months during a period of 7 years from August 2014 to June 2021. A detailed history, physical examination, and computed tomography scan were done in all the cases. Based on patient condition, aetiology and parents choice, 30 patients were treated by Endoscopic third ventriculostomy and 40 patients were treated by ventriculoperitoneal shunt. At enrolment, baseline clinical data were collected. Postoperative data were collected, including assessments of complications and treatment failures. Results: A total of 70 infants with hydrocephalus were enrolled in the study and out of them, 30 (42.86%) underwent ETV and 40 (57.14%) underwent VP shunt for the initial treatment of their hydrocephalus. The mean age of patients was 6.4±1.2 months with a range of 18 days to 342 days. Clinical improvement was shown in 76.67% and 70% in ETV and VP shunt groups respectively. No significant difference (p=0.53) was observed in clinical outcomes in both groups. In the 1 to 6 months of age group, 07 (30.43%) clinically improved patients were from the ETV group, while in the VP shunt group, 10 (35.71%) patients showed improvement. In the 7 to 12 months age group, 16 (69.57%) clinically improved patients were from the ETV group and 18 (64.29%) patients were from the VP shunt group (p=0.69). Association of treatment success with gender, term of gestation and aetiology of hydrocephalus was not statistical significant (p&gt;0.05). Out of 70 patients with hydrocephalus, postoperative complications such as infection, CSF leak, haemorrhage and blockage was found in 09 (12.86%), 08 (11.43%), 05 (7.14%) and 08 (11.43%) patients respectively. A significant higher proportion of infection (p=0.043) and blockage (p=0.023) was found in the VP shunt group than in the ETV group. Conclusion: Treatment success was high in both procedures. VP shunt was found to be more successful than ETV in terms of clinical outcome in both age groups. However, the results were statistically insignificant. A significantly higher proportion of complications was found with VP shunt than ETV therefore greater benefits can be achieved using ETV. Thus for a tribal population, where patient compliance is poor and healthcare accessibility, as well as regular follow-up, is difficult, a procedure like ETV can be considered better than VP shunt.