Five-year outcomes after surgical treatment of infant postinfectious hydrocephalus in sub-Saharan Africa: results of a randomized trial

OBJECTIVE Postinfectious hydrocephalus (PIH) in infants is a major public health burden in sub-Saharan Africa. In a previously reported randomized trial, the authors found no significant differences in outcome between endoscopic versus shunt treatment, with stagnation in brain growth at 2 years after treatment. They now present the 5-year follow-up results of this cohort, assessing detailed developmental, quality of life, and brain volume outcomes. METHODS The authors performed a trial at a single center in Mbale, Uganda, involving 100 infants (< 180 days of age) with PIH randomized to endoscopic third ventriculostomy plus choroid plexus cauterization (ETV/CPC) or ventriculoperitoneal shunt (VPS) treatment. After 5 years, they assessed developmental outcomes with the Vineland Adaptive Behavior Scales, Third Edition (VABS-3), quality of life with the Health Utilities Index Mark 3 (HUI-3) and Hydrocephalus Outcome Questionnaire (HOQ), and brain volume derived from CT scans. RESULTS Sixty-three infants were assessed for 5-year outcomes (35 ETV/CPC and 28 VPS, by intention to treat). There were no significant differences between the two surgical treatment arms in treatment failure (p = 0.39), VABS-3 scores (p > 0.52), HUI-3 utility scores (p > 0.37), HOQ scores (p > 0.18), or brain volume (raw p = 1.0, adjusted p = 0.24). There were strong correlations between VABS-3, HUI-3, and HOQ scores with brain volume adjusted for age and sex, and weaker correlations when adjusted for anthropometric measurements. CONCLUSIONS These results suggest that ETV/CPC and VPS treatment have comparable long-term outcomes for infants in medically resource-constrained environments. Furthermore, brain volume strongly correlates with developmental and quality of life metrics, emphasizing the need to focus on optimizing brain volume growth potential in infants with severe perinatal neurological insults such as infection and hydrocephalus.