Treating Pediatric Hydrocephalus at the Neurosurgery Education and Development Institute: The Reality in the Zanzibar Archipelago, Tanzania

• Published in: World neurosurgery 2018-09, Vol.117, p.e450-e456
• Main Authors: Leidinger, Andreas, Piquer, Jose, Kim, Eliana E., Nahonda, Hadia, Qureshi, Mahmood M., Young, Paul H.
• Format: Article
• Language: English
• Subjects: East Africa; Pediatric hydrocephalus; Postinfectious hydrocephalus; Ventriculoperitoneal shunt; Zanzibar
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.06.050

Pediatric hydrocephalus is a health burden for East African countries, with an estimated incidence of 6000 new cases per year. The objective of this study is to describe the epidemiology and surgical outcomes of patients treated for pediatric hydrocephalus in the single neurosurgical center of Zanzibar. From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of hydrocephalus. Information was gathered regarding demographics, maternal health, preoperative imaging, surgical procedures, and postsurgical complications. We collected data on 63 patients. Average age was 203 days, and gender was 49.2% female and 50.8% male. All mothers of patients attended an antenatal clinic for routine screening during pregnancy. Folic acid prophylaxis was used by 9.5% of the mothers during pregnancy. At the first visit, 46.0% of patients presented with signs of infection, 20.6% with congenital abnormalities, and 20.6% with seizures. Regarding etiology of hydrocephalus, 22.2% of all cases were uncertain; 20.6% were associated with neural tube defects; 39.7% were postinfectious hydrocephalus; 3.2% were aqueduct stenosis; 4.8% were associated with brain tumor; and 9.6% were malformative. We performed 7 endoscopic third ventriculostomies and placed 40 ventriculoperitoneal shunts. The complication rate at follow-up was 12.5%. It seems that hydrocephalus in Zanzibar has similar causes, progression, and complication rates to previous reports from other African hospitals. Further studies of postinfectious hydrocephalus need to be conducted because recent findings suggest that it is a potentially preventable cause of the disease. •Pediatric hydrocephalus is a health burden for East African countries, affecting >6000 infants annually.•An appropriate surgical decision-making algorithm is needed for the management of hydrocephalus.•Endoscopic third ventriculostomy offers a valuable diagnostic and therapeutic alternative in some cases.•PIH is a significant cause of pediatric hydrocephalus in East Africae.•Early management of infections in newborns could reduce the incidence of hydrocephalus.