Work

Pediatric hydrocephalus management at a major neurosurgical referral center in Kumasi, Ghana

Year: 2025

Type: article

Abstract: INTRODUCTION: This study aims to determine the presentation and treatment of pediatric hydrocephalus at a major neurosurgical referral center in Ghana and compare outcomes between ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC). METHODS: An ambispective study of pediatric hydrocephalus patients managed at Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana, was performed between 2019 and 2023. Patient demographics, etiology, surgical details, and outcomes were collected and analyzed. The primary outcomes were treatment failure and time to failure (TTF). RESULTS: A total of 325 patients were included in the study. Median age at presentation was 6.9 months (IQR 1.4, 36.4), and 52% were male. The predominant etiologies were myelomeningocele-associated hydrocephalus (23%) and post-infectious hydrocephalus (21%). Macrocephaly (89%) and bulging fontanelle (73%) were the frequent clinical presentations. Of the 247 patients (76%) who underwent CSF diversion, 70% underwent VPS, 19% underwent ETV, and 11% underwent ETV/CPC. The median time from presentation to surgical management was 29 (IQR 8, 83) days. Thirty-day surgical mortality was 8%. Median postoperative length of stay was 7 days (IQR 5, 14). Six percent of VPS patients and 9% of ETV ± CPC patients required re-intervention with a median TTF of 2.5 months and 1.5 months respectively (p = 0.40). At a median follow-up duration of 15 months (IQR 6, 29), 69% of patients were alive. CONCLUSION: There is a substantial pediatric hydrocephalus burden at KATH in Kumasi-Ghana. ETV ± CPC and VPS demonstrate comparable treatment success. Public health interventions aimed at prevention and provision of timely neurosurgical care may help reduce disease burden and improve outcomes.

Source: Child s Nervous System

DOI: 10.1007/s00381-025-06960-9