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Introduction <p>This study aims to determine the presentation and treatment of pediatric hydrocephalus at a major neurosurgical referral center in Ghana and compare outcomes between ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC).</p> Methods <p>An ambispective study of pediatric hydrocephalus patients managed at Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana, was performed between 2019 and 2023. Patient demographics, etiology, surgical details, and outcomes were collected and analyzed. The primary outcomes were treatment failure and time to failure (TTF).</p> Results <p>A total of 325 patients were included in the study. Median age at presentation was 6.9&#xa0;months (IQR 1.4, 36.4), and 52% were male. The predominant etiologies were myelomeningocele-associated hydrocephalus (23%) and post-infectious hydrocephalus (21%). Macrocephaly (89%) and bulging fontanelle (73%) were the frequent clinical presentations. Of the 247 patients (76%) who underwent CSF diversion, 70% underwent VPS, 19% underwent ETV, and 11% underwent ETV/CPC. The median time from presentation to surgical management was 29 (IQR 8, 83) days. Thirty-day surgical mortality was 8%. Median postoperative length of stay was 7&#xa0;days (IQR 5, 14). Six percent of VPS patients and 9% of ETV ± CPC patients required re-intervention with a median TTF of 2.5&#xa0;months and 1.5&#xa0;months respectively (<i>p</i> = 0.40). At a median follow-up duration of 15&#xa0;months (IQR 6, 29), 69% of patients were alive.</p> Conclusion <p>There is a substantial pediatric hydrocephalus burden at KATH in Kumasi-Ghana. ETV ± CPC and VPS demonstrate comparable treatment success. Public health interventions aimed at prevention and provision of timely neurosurgical care may help reduce disease burden and improve outcomes.</p>

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Pediatric hydrocephalus management at a major neurosurgical referral center in Kumasi, Ghana

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月29日

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  • Joseline Haizel-Cobbina,
  • Christian Coompson,
  • Samuel Addy,
  • Kwadwo Darko,
  • Derrick Obiri-Yeboah,
  • Kwaku Ampofo,
  • Dickson Bandoh,
  • Benedict Owusu,
  • Anthony Lamina,
  • Jeffrey P. Blount,
  • James M. Johnston,
  • Michael C. Dewan,
  • Frank Nketiah-Boakye

摘要

Introduction

This study aims to determine the presentation and treatment of pediatric hydrocephalus at a major neurosurgical referral center in Ghana and compare outcomes between ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC).

Methods

An ambispective study of pediatric hydrocephalus patients managed at Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana, was performed between 2019 and 2023. Patient demographics, etiology, surgical details, and outcomes were collected and analyzed. The primary outcomes were treatment failure and time to failure (TTF).

Results

A total of 325 patients were included in the study. Median age at presentation was 6.9 months (IQR 1.4, 36.4), and 52% were male. The predominant etiologies were myelomeningocele-associated hydrocephalus (23%) and post-infectious hydrocephalus (21%). Macrocephaly (89%) and bulging fontanelle (73%) were the frequent clinical presentations. Of the 247 patients (76%) who underwent CSF diversion, 70% underwent VPS, 19% underwent ETV, and 11% underwent ETV/CPC. The median time from presentation to surgical management was 29 (IQR 8, 83) days. Thirty-day surgical mortality was 8%. Median postoperative length of stay was 7 days (IQR 5, 14). Six percent of VPS patients and 9% of ETV ± CPC patients required re-intervention with a median TTF of 2.5 months and 1.5 months respectively (p = 0.40). At a median follow-up duration of 15 months (IQR 6, 29), 69% of patients were alive.

Conclusion

There is a substantial pediatric hydrocephalus burden at KATH in Kumasi-Ghana. ETV ± CPC and VPS demonstrate comparable treatment success. Public health interventions aimed at prevention and provision of timely neurosurgical care may help reduce disease burden and improve outcomes.