Pediatric Hydrocephalus in Ethiopia: Treatment Failures and Infections: A Hospital-Based, Retrospective Study

Objective/Background Treatment of pediatric hydrocephalusin sub-Saharan countries is associated with significant complication rates. The objective of this study is to analyze the management of hydrocephalusand complication rates of surgical intervention in the Ethiopian setting to improve future quality. Methods A retrospective cohort study was conducted in a neurosurgical teaching hospital. Two cohorts separated by 2.5 years were analyzed. Results A total of 128 (58.6% male and 41.4% female) children with isolated hydrocephalus, meningomyelocele (MMC)-related hydrocephalus, or MMC without hydrocephaluswere included. Their age ranged from 1 day to 5 years, for a mean age of 7.2 months (median age 2 months). One hundred thirteen patients had hydrocephalus, of whom 57 (44.5.3%) had isolated hydrocephalusand 56 (43.8%) had hydrocephalusassociated with MMC. Seventy-seven (74.7%) patients underwent ventriculoperitoneal (VP) shunting, whereas 24 (23.3%) underwent endoscopic third ventriculostomy(ETV). The incidence of shuntinfection was 23.4%. Reoperation was needed in 54 (52.4%) patients, with the most common indication being shuntfailure. ETV failed in 14 (58.3%) of the 24 patients undergoing ETV. Conclusions VP shuntinsertions had unacceptably high infection rate despite the presence of a protocol for the procedure. Intraoperative guidelines should be developed further and followed strictly to reduce infections. Such measures should include restricting the number of surgeons performing the procedure. In our opinion, one should avoid insertion of a VP shuntas the primary treatment. ETV has proved to be a good alternative in other studies and the decreasing pattern of ETV failure in our study also suggest ETV as a better alternative to VP shunt.