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Mortality and complications 1 year after treatment of hydrocephalus with endoscopic third ventriculostomy and ventriculoperitoneal shunt in children at Queen Elizabeth Central Hospital, Malawi

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Over the past two decades, the management of hydrocephalus has witnessed the addition of endoscopic third ventriculostomy with or without choroid plexus cauterization (ETV ± CPC) to the traditional methods including ventriculoperitoneal shunt insertion (VPSI). We conducted this study to assess mortality and complications with surgical implications associated with the two procedures in children with hydrocephalus.


We reviewed our operating theater registry to identify children below 17 years old who underwent hydrocephalus surgery for the first time in 2016. The patients were followed for up to 1 year from the date of the initial operation. Their vital status was confirmed by follow-up visits by a community nurse. Descriptive analyses were used to describe the characteristics of the patients and evaluate the study outcomes (i.e., mortality and complications).


One hundred fifty-three patients were eligible for the study; 56% were males and 73.2% had primary ETV ± CPC. Complete 1-year follow-up data was available for 79 patients, and 73.4% of these had ETV ± CPC. One-year success (event-free) rates for ETV and VPSI were similar at 67.4% and 66.7%, respectively. ETVs in infants under 6 months performed poorly; failing in half the infants, who were subsequently converted to VPS. Shunt sepsis was very high, 21.4% (95% CI 10.3–36.8). The majority of surgical complications (81.8%) occurred within 3 months of surgery.


ETV ± CPC and VPSI carry a similar frequency of mortality and complications in our setting, and therefore, both should be considered as a treatment option for patients with hydrocephalus. As VP shunt is still used for managing most of the patients, there is still a need to prioritize measures to reduce shunt infections.

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Choroid plexus cauterization


Cerebrospinal fluid


External ventricular drain


Endoscopic third ventriculostomy


Inter-quartile range


Ventriculoperitoneal shunt insertion


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We acknowledge Favour Kaunda for her assistance through the community nursing service and Linda Kalirani-Phiri for her assistance with (language) editing and proofreading.

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Authors and Affiliations



CM—research conception, literature review, data collection, data analysis, manuscript preparation, and approval of the final draft

HC—data analysis, first draft preparation and literature review, editing of further drafts, and approval of the final draft

PK—research conception, data analysis, manuscript preparation, editing of all drafts, and preparation of the final draft

The authors read and approved the final manuscript.

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Correspondence to C. Hara.

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Table 1

Table 1 One-year epidemiology, management, and causes of hydrocephalus

Table 2

Table 2 One-year mortality and surgical morbidity profiles of children aged 16 years and below, treated for hydrocephalus with endoscopic third ventriculostomy and ventriculoperitoneal shunts

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Chimaliro, S., Hara, C. & Kamalo, P. Mortality and complications 1 year after treatment of hydrocephalus with endoscopic third ventriculostomy and ventriculoperitoneal shunt in children at Queen Elizabeth Central Hospital, Malawi. Acta Neurochir 165, 61–69 (2023).

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