Five-year survival and outcome of treatment for postinfectious hydrocephalus in Ugandan infants

Clinical article

Benjamin C. Warf Department of Neurosurgery, Children's Hospital Boston, Harvard Medical School;
Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston;

Search for other papers by Benjamin C. Warf in
jns
Google Scholar
PubMed
Close
 M.D.
,
Ariella R. Dagi Harvard College, Cambridge, Massachusetts;

Search for other papers by Ariella R. Dagi in
jns
Google Scholar
PubMed
Close
 B.A.
,
Brian Nsubuga Kaaya CURE Children's Hospital of Uganda, Mbale, Uganda; and

Search for other papers by Brian Nsubuga Kaaya in
jns
Google Scholar
PubMed
Close
 B.S.
, and
Steven J. Schiff Center for Neural Engineering, Departments of Neurosurgery, Engineering Science and Mechanics, and Physics, The Pennsylvania State University, University Park, Pennsylvania

Search for other papers by Steven J. Schiff in
jns
Google Scholar
PubMed
Close
 M.D., Ph.D.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $536.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $45.00
USD  $536.00
USD  $636.00
Print or Print + Online Sign in

Object

Neonatal infection is the most common cause of infant hydrocephalus in Uganda. Postinfectious hydrocephalus (PIH) is often accompanied by primary brain injury from the original infection. Since 2001, ETV (with or without choroid plexus cauterization) has been our primary treatment for PIH. The long-term outcome in these children is unknown.

Methods

We studied the 5-year outcome in a cohort of 149 infants treated for PIH from 2001 to 2005 and who lived in 4 districts close to the hospital. Survival analysis was performed using the Kaplan-Meier method. Statistical significance was determined using the Fisher, Breslow, and log-rank tests.

Results

The patients' mean age at presentation was 9.5 months (median 3.0 months). Eighty-four patients (56.4%) were successfully treated without a shunt. Operative mortality was 1.2% for ETV and 4.4% for shunt placement (p = 0.3). Five-year survival was 72.8% in the non–shunt-treated group and 67.6% in the shunt-treated group, with no difference in survival (log rank p = 0.43, Breslow p = 0.46). Of 43 survivors assessed at 5–11 years, those with shunts had significantly worse functional outcomes (p = 0.003–0.035), probably reflecting treatment selection bias since those with the worst sequelae of ventriculitis were more likely to be treated with shunt placement.

Conclusions

Nearly one-third of treated infants died within 5 years, and at least one-third of the survivors were severely disabled. There was no survival advantage for non–shunt-treated patients at 5 years. A randomized trial of endoscopic third ventriculostomy versus shunt placement for treating PIH may be indicated. Public health measures that prevent these infections are urgently needed.

Abbreviations used in this paper:

CCHU = CURE Children's Hospital of Uganda; CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; PIH = postinfectious hydrocephalus; VP = ventriculoperitoneal.
  • Collapse
  • Expand
  • 1

    Li L, , Padhi A, , Ranjeva SL, , Donaldson SC, , Warf BC, & Mugamba J, et al.: Association of bacteria with hydrocephalus in Ugandan infants. Clinical article. J Neurosurg Pediatr 7:7387, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Warf BC: Comparison of 1-year outcomes for the Chaabra and Codman-Hakim Micro Precision shunt systems in Uganda: a prospective study in 195 children. J Neurosurg 102:4 Suppl 358362, 2005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Warf BC: Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. J Neurosurg 103:6 Suppl 475481, 2005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Warf BC: Hydrocephalus associated with neural tube defects: characteristics, management, and outcome in sub-Saharan Africa. Childs Nerv Syst (in press)

  • 5

    Warf BC: Hydrocephalus in Uganda: predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg 102:1 Suppl 115, 2005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Warf BC, , Alkire BC, , Bhai S, , Hughes C, , Schiff S, & Vincent JR, et al.: Costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa. Clinical article. J Neurosurg Pediatr 8:509521, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Warf BC, & Campbell JW: Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocele: long-term results of a prospective intent-to-treat study in 115 East African infants. Clinical article. J Neurosurg Pediatr 2:310316, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Warf BC, , Campbell JW, & Riddle E: Initial experience with combined endoscopic third ventriculostomy and choroid plexus cauterization for post-hemorrhagic hydrocephalus of prematurity: the importance of prepontine cistern status and the predictive value of FIESTA MRI imaging. Childs Nerv Syst 27:10631071, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Warf BC, , Dewan M, & Mugamba J: Management of Dandy-Walker complex–associated infant hydrocephalus by combined endoscopic third ventriculostomy and choroid plexus cauterization. Clinical article. J Neurosurg Pediatr 8:377383, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Warf BC, & Kulkarni AV: Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children. Clinical article. J Neurosurg Pediatr 5:204209, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Warf BC, , Ondoma S, , Kulkarni A, , Donnelly R, , Ampeire M, & Akona J, et al.: Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda. Clinical article. J Neurosurg Pediatrics 4:564570, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Warf BC, , Stagno V, & Mugamba J: Encephalocele in Uganda: ethnic distinctions in lesion location, endoscopic management of hydrocephalus, and survival in 110 consecutive children. Clinical article. J Neurosurg Pediatr 7:8893, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Warf BC, , Wright EJ, & Kulkarni AV: Factors affecting survival of infants with myelomeningocele in southeastern Uganda. Clinical article. J Neurosurg Pediatr 7:127133, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1841 242 12
Full Text Views 229 23 0
PDF Downloads 159 23 1
EPUB Downloads 0 0 0