S. Scarlet1, J. Gallaher1, A. Charles1 1University Of North Carolina At Chapel Hill,Acute Care Surgery/General Surgery,Chapel Hill, NC, USA
Introduction: The prevalence of hydrocephalus is greatest in developing countries, where access to neurosurgical care is limited. Hydrocephalus is the most common indication for pediatric neurosurgery worldwide. Untreated disease is associated with severe neurological disability and a high mortality rate. Additionally, there is paucity of data regarding the long-term outcomes of children following ventriculoperitoneal (VP) shunt placement.
Methods: We completed a retrospective review of all children diagnosed with hydrocephalus from March 2015 until June 2016 at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi.
Results: Hydrocephalus was diagnosed based on clinical exam, ultrasound, and measurement of intracerebral pressure via ventricular aspiration in 100 children (45% female). All children underwent VP shunt placement during the 17-month study period. Average age at diagnosis was 4.9 months (SD 5). Presenting signs were enlarged head circumference (94%), seizure disorder (22%), irritability (26%) and meningitis (24%). At the time of surgery, mean weight was 6.3 kg (SD 2.5) and mean head circumference was 52.1 cm (SD 8.6). Mean post-operative length of stay was 27 days (SD 14). Crude in-hospital mortality was 4%. Five children required shunt revision for exposed shunt (n=4) and occluded shunt (n=1). 43 patients had follow-up at home within six months of VP shunt placement. 22 children (51%) died within the six-month follow-up period. Among children who had follow-up, a higher mean head circumference (cm) to weight (kg) ratio was associated with late mortality, 10.2 vs. 7.5 (p=0.01).
Conclusion: In sub-Saharan Africa, the high prevalence of pediatric hydrocephalus is attributed to higher birth rates, poor prenatal care, and increased likelihood of meningitis in the perinatal and neonatal period. In our study, the follow-up mortality rate was very high, especially for patients with a high head circumference to weight ratio. More research is needed to determine the appropriate patient population and optimal time for VP shunt placement in a resource-poor setting.