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Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome

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Abstract

Purpose

Surgery for children in developing nations is challenging. Endoscopic third ventriculostomy (ETV) is an important surgical treatment for childhood hydrocephalus and has been performed in developing nations, but with lower success rates than in developed nations. It is not known if the lower success rate is due to inherent differences in prognostic factors.

Methods

We analyzed a large cohort of children (≤20 years old) treated with ETV in developed nations (618 patients from Canada, Israel, United Kingdom) and developing nations of sub-Saharan Africa (979 patients treated in Uganda). Risk-adjusted survival analysis was performed.

Results

The risk of an intra-operative ETV failure (an aborted procedure) was significantly higher in Uganda regardless of risk adjustment (hazard ratio (HR), 95% confidence interval (CI), 11.00 (6.01 to 19.84) P < 0.001). After adjustment for patient prognostic factors and technical variation in the procedure (the use of choroid plexus cauterization), there was no difference in the risk of failure for completed ETVs (HR, 95% CI, 1.04 (0.83 to 1.29), P = 0.74).

Conclusions

Three factors account for all significant differences in ETV failure between Uganda and developed nations: patient prognostic factors, technical variation in the procedure, and intra-operatively aborted cases. Once adjusted for these, the response to completed ETVs of children in Uganda is no different than that of children in developed nations.

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Funding

No external funds were received for this study. The authors have no conflicts of interest related to this manuscript. Dr. Kulkarni had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Author information

Authors and Affiliations

  1. Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Room 1503, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8

    Abhaya V. Kulkarni & James M. Drake

  2. Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA

    Benjamin C. Warf

  3. CURE Children’s Hospital of Uganda, Mbale, Uganda

    Benjamin C. Warf

  4. Royal Liverpool Children’s Hospital, Liverpool, UK

    Conor L. Mallucci

  5. Department of Neurosurgery, “Attikon” University Hospital, University of Athens, Athens, Greece

    Spyros Sgouros

  6. Dana Children’s Hospital, Tel-Aviv Medical Center, Tel Aviv, Israel

    Shlomi Constantini

Authors
  1. Abhaya V. Kulkarni
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  2. Benjamin C. Warf
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  3. James M. Drake
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  4. Conor L. Mallucci
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  5. Spyros Sgouros
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  6. Shlomi Constantini
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Consortia

and the Canadian Pediatric Neurosurgery Study Group

Corresponding author

Correspondence to Abhaya V. Kulkarni.

Additional information

Canadian Pediatric Neurosurgery Study Group (see Appendix 1 for list of members)

Appendix 1. Contributing members of the Canadian Pediatric Neurosurgery Study Group

Appendix 1. Contributing members of the Canadian Pediatric Neurosurgery Study Group

Alberta Children’s Hospital, Calgary, Canada: W Hader; M Hamilton; Children’s & Women’s Health Centre of BC, Vancouver, Canada: DD Cochrane, P Steinbok; Children’s Hospital of Eastern Ontario, Ottawa, Canada: M Vassilyadi, E Ventureyra; Hospital for Sick Children, Toronto, Canada: PB Dirks, JM Drake, AV Kulkarni, JT Rutka, A Van der Stoel, I Veltman; IWK Health Centre, Halifax, Canada: W Howes, PD McNeely, SA Walling; London Health Sciences Centre, London, Canada: A Ranger; Montreal Children’s Hospital, Montreal, Canada: J Atkinson, JP Farmer, J Montes; Stollery Children’s Hospital, Edmonton, Canada: K Aronyk, V Mehta; Winnipeg Children’s Hospital , Winnipeg, Canada: PJ McDonald

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Kulkarni, A.V., Warf, B.C., Drake, J.M. et al. Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome. Childs Nerv Syst 26, 1711–1717 (2010). https://doi.org/10.1007/s00381-010-1195-x

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  • DOI: https://doi.org/10.1007/s00381-010-1195-x

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