Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda

Abhaya V. Kulkarni, Steven J. Schiff, Edith Mbabazi-Kabachelor, John Mugamba, Peter Ssenyonga, Ruth Donnelly, Jody Levenbach, Vishal Monga, Mallory Peterson, Michael MacDonald, Venkateswararao Cherukuri, Benjamin C. Warf

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33 Scopus citations

Abstract

BACKGROUND Postinfectious hydrocephalus in infants is a major health problem in sub-Saharan Africa. The conventional treatment is ventriculoperitoneal shunting, but surgeons are usually not immediately available to revise shunts when they fail. Endoscopic third ventriculostomy with choroid plexus cauterization (ETV-CPC) is an alternative treatment that is less subject to late failure but is also less likely than shunting to result in a reduction in ventricular size that might facilitate better brain growth and cognitive outcomes. METHODS We conducted a randomized trial to evaluate cognitive outcomes after ETV-CPC versus ventriculoperitoneal shunting in Ugandan infants with postinfectious hydrocephalus. The primary outcome was the Bayley Scales of Infant Development, Third Edition (BSID-3), cognitive scaled score 12 months after surgery (scores range from 1 to 19, with higher scores indicating better performance). The secondary outcomes were BSID-3 motor and language scores, treatment failure (defined as treatment-related death or the need for repeat surgery), and brain volume measured on computed tomography. RESULTS A total of 100 infants were enrolled; 51 were randomly assigned to undergo ETV-CPC, and 49 were assigned to undergo ventriculoperitoneal shunting. The median BSID-3 cognitive scores at 12 months did not differ significantly between the treatment groups (a score of 4 for ETV-CPC and 2 for ventriculoperitoneal shunting; Hodges-Lehmann estimated difference, 0; 95% confidence interval [CI],-2 to 0; P=0.35). There was no significant difference between the ETV-CPC group and the ventriculoperitoneal-shunt group in BSID-3 motor or language scores, rates of treatment failure (35% and 24%, respectively; hazard ratio, 0.7; 95% CI, 0.3 to 1.5; P=0.24), or brain volume (z score,-2.4 and-2.1, respectively; estimated difference, 0.3; 95% CI,-0.3 to 1.0; P=0.12). CONCLUSIONS This single-center study involving Ugandan infants with postinfectious hydrocephalus showed no significant difference between endoscopic ETV-CPC and ventriculoperitoneal shunting with regard to cognitive outcomes at 12 months.

Original languageEnglish (US)
Pages (from-to)2456-2464
Number of pages9
JournalNew England Journal of Medicine
Volume377
Issue number25
DOIs
StatePublished - Dec 21 2017

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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    Kulkarni, A. V., Schiff, S. J., Mbabazi-Kabachelor, E., Mugamba, J., Ssenyonga, P., Donnelly, R., Levenbach, J., Monga, V., Peterson, M., MacDonald, M., Cherukuri, V., & Warf, B. C. (2017). Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda. New England Journal of Medicine, 377(25), 2456-2464. https://doi.org/10.1056/NEJMoa1707568