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Hydrocephalus in toddlers: the place of shunts in sub-Sahara African countries

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Abstract

Purpose

This study describes the epidemiological patterns of hydrocephalus in toddlers in our setting in order to determine the proportion of those who could benefit from endoscopic third ventriculostomy (ETV).

Methods

This prospective and descriptive study included all toddlers operated on for hydrocephalus from 1 March 2008 to 31 March 2010 at the Yaounde Central Hospital.

Results

Forty-six toddlers were included representing 72% of all hydrocephalus cases managed at the Neurosurgery Unit during the study period. The mean age was 6.9 ± 1.6 months. The delay before treatment varied from 5 days to 15.8 months (mean = 3.7 ± 0.5 months). The commonest clinical presentation was macrocrania (78.3%). Of the toddlers, 58.7% presented with a probable blindness (loss of ocular pursuit); dilated and non-reactive pupils were found in nine patients (19.6%). The diagnosis was based on transfontanellar echography (TFE), CT scan or combined TFE and CT scan. Identified aetiologies were aqueduct stenosis (28.7%), haemorrhage (18%), Dandy–Walker’s syndrome (14.3%), meningitis (10.8%), myelomeningocele (10.8%), agenesis of Monro’s foramen (3.6%), brain abscess (3.2%) and posterior fossa tumour (3.6%). No specific cause was found in 7% of cases. The treatment was ventriculoperitoneal shunting in 42 cases (91.3%) and ETV in two cases (4.3%). Infections (11.1%) and shunts’ obstruction (5.4%) were the main complications.

Conclusion

Cases of hydrocephalus in toddlers are frequent in our setting. Regardless of the patient’s age, the most prevailing aetiologies (infections, haemorrhage, myelomeningocele) and technological conditions (neuroendoscope) are less favourable for ETV. The use of ETV in the treatment of hydrocephalus in sub-Saharan Africa is still marginal and needs to be encouraged in selected cases. The prevention of non-tumoral hydrocephalus is of critical importance.

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Acknowledgement

We are grateful to all the staff that contributed to the realization of the present study. We also thank all parents who gave their consent for their children to take part in this study. This study was approved by the Cameroon National Ethical Committee.

Declaration of interest

This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. No conflict of interest was reported by the authors.

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Authors and Affiliations

  1. Neurosurgery Unit, Yaounde Central Hospital, Yaounde, Cameroon

    Vincent de paul Djientcheu, T. Yves Yamgoue & Figuim Bello

  2. Neuropaediatrics Unit, Yaounde Gyneco-Obstetrics and Paediatrics Hospital, Yaounde, Cameroon

    Seraphin Nguefack & Elie Mbonda

  3. Paediatric Surgery Unit, Yaounde Gyneco-Obstetrics and Paediatrics Hospital, Yaounde, Cameroon

    T. Olivier Mouafo

  4. Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon

    Vincent de paul Djientcheu, Seraphin Nguefack, T. Olivier Mouafo, A. Stephane Mbarnjuk, Giles Kagmeni & Elie Mbonda

  5. Neurosurgery Unit, Geneva University Hospital, Geneva, Switzerland

    Benedict Rilliet

Authors
  1. Vincent de paul Djientcheu
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  2. Seraphin Nguefack
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  3. T. Olivier Mouafo
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  4. A. Stephane Mbarnjuk
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  5. T. Yves Yamgoue
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Correspondence to Vincent de paul Djientcheu.

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Djientcheu, V., Nguefack, S., Mouafo, T.O. et al. Hydrocephalus in toddlers: the place of shunts in sub-Sahara African countries. Childs Nerv Syst 27, 2097–2100 (2011). https://doi.org/10.1007/s00381-011-1548-0

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  • DOI: https://doi.org/10.1007/s00381-011-1548-0

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