Short-term outcomes of endoscopic third ventriculostomy and choroid plexus cauterization in children with hydrocephalus at Arusha Lutheran Medical Centre in northern Tanzania: a retrospective study

OBJECTIVE Despite progress in building surgical infrastructure in East Africa, access to neurosurgical care remains challenging. More than 6000 new cases of pediatric hydrocephalus occur each year in sub-Saharan Africa, but only approximately 50 neurosurgeons are available to treat those cases. Treatment for pediatric hydrocephalus typically involves placement of a ventriculoperitoneal (VP) shunt, but recently the treatment focus has broadened to revisit endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC). However, it is unknown whether ETV with CPC (ETV/CPC) is safe and efficacious in low- and middle-income countries for infants younger than 1 year. This study investigated the implementation of ETV/CPC at a low-resource hospital in northern Tanzania. METHODS The authors conducted a single-center retrospective study investigating short-term outcomes of ETV/CPC at Arusha Lutheran Medical Centre in Tanzania. Study participants were children 0–18 years old with a diagnosis of hydrocephalus who underwent ETV with or without CPC between February 1, 2020, and February 1, 2022. Data captured included demographics, patient hydrocephalus etiology, and ETV Success Score. Successful treatment was defined as successful control of the hydrocephalus without the need for further shunt placement from the time of ETV through the 3-month follow-up. RESULTS During the study period, 54 ETV procedures for hydrocephalus were performed, 45 with and 9 without CPC. The mean (SD) patient age at the time of ETV was 1.75 (2.37) years (range < 1 to 10 years). ETV was successful in 49 patients (91%). Five cases (9%) were complicated by significant morbidity or mortality: 3 cases required VP shunt placement and 2 patients died. Most patients (70%) were younger than 1 year at the time of surgery. The failure rate of ETV was 8% (3 of 38) among patients aged 1 year or younger and 13% (2 of 16) among patients older than 1 year. CONCLUSIONS At this institution, ETV with or without CPC was found to be an alternative treatment option when compared to VP shunting. This study also found that these procedures can be safely performed in children younger than 1 year and can avoid the need for VP shunts in many patients. Further research is needed to evaluate the long-term outcomes of these patients.