Endoscopic third ventriculostomy with choroid plexus cauterization for the treatment of infantile hydrocephalus in Haiti
| Autor: | Iahn Cajigas, John Ragheb, Ariel Henry, Ernest J. Barthélemy, George M. Ibrahim, Stephanie H Chen, Ashish H. Shah, Yudy Lafortune, Michael Ragheb |
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| Rok vydání: | 2020 |
| Předmět: |
Ventriculostomy
medicine.medical_specialty Univariate analysis Multivariate analysis business.industry medicine.medical_treatment Endoscopic third ventriculostomy General Medicine Infantile hydrocephalus medicine.disease Surgery Hydrocephalus 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis medicine Cauterization Choroid plexus business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurosurgery: Pediatrics. 25:411-416 |
| ISSN: | 1933-0715 1933-0707 |
| DOI: | 10.3171/2019.10.peds19433 |
| Popis: | OBJECTIVEUntreated hydrocephalus poses a significant health risk to children in the developing world. In response to this risk, global neurosurgical efforts have increasingly focused on endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) in the management of infantile hydrocephalus in low- and middle-income countries (LMICs). Here, the authors report their experience with ETV/CPC at the Hospital Bernard-Mevs/Project Medishare (HBMPM) in Port-au-Prince, Haiti.METHODSThe authors conducted a retrospective review of a series of consecutive children who had undergone ETV/CPC for hydrocephalus over a 1-year period at HBMPM. The primary outcome of interest was time to ETV/CPC failure. Univariate and multivariate analyses using a Cox proportional hazards regression were performed to identify preoperative factors that were associated with outcomes.RESULTSOf the 82 children who underwent ETV/CPC, 52.2% remained shunt free at the last follow-up (mean 6.4 months). On univariate analysis, the ETV success score (ETVSS; p = 0.002), success of the attempted ETV (p = 0.018), and bilateral CPC (p = 0.045) were associated with shunt freedom. In the multivariate models, a lower ETVSS was independently associated with a poor outcome (HR 0.072, 95% CI 0.016–0.32, p < 0.001). Two children (2.4%) died of postoperative seizures.CONCLUSIONSAs in other LMICs, ETV/CPC is an effective treatment for hydrocephalus in children in Haiti, with a low but significant risk profile. Larger multinational prospective databases may further elucidate the ideal candidate for ETV/CPC in resource-poor settings. |
| Databáze: | OpenAIRE |
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