Neurosurgery Resident Penn State College of Medicine
Introduction: Post-infectious hydrocephalus in infants is a major public health burden in sub-Saharan Africa. In a previously reported randomized trial, we found no significant differences in outcome between endoscopic versus shunt treatment, with stagnation in brain growth at 2 years after treatment. We now present the 5-year follow-up results of this cohort assessing detailed developmental, quality of life, and brain volume outcomes.
Methods: We performed a trial at a single center in Mbale, Uganda involving infants ( < 180 days old) with post-infectious hydrocephalus randomized to endoscopic third ventriculostomy plus choroid plexus cauterization (ETV/CPC) or ventriculoperitoneal shunt (VPS). After 5 years, we assessed developmental outcome with the Vineland Adaptive Behavior Scales-III (VABS-3), quality of life with Health Utilities Index Mark 3 (HUI-3) and Hydrocephalus Outcome Questionnaire (HOQ), and brain volume derived from computed tomography (CT) scans.
Results: Sixty-three infants were assessed for 5-year outcome (ETV/CPC N=35, VPS N=28, by intention-to-treat). There were no significant differences between the two surgical treatment arms in treatment failure (p=0.39), VABS-3 scores (p>0.52), HUI-3 utility scores (p>0.37), HOQ scores (p>0.18) or brain volume (raw p=1.0, adjusted p=0.24). There were strong correlations between VABS, HUI-3, and HOQ scores with brain volume adjusted for age, sex, and weaker correlations when adjusted for anthropometric measurements.
Conclusion : These results suggest that ETV/CPC and VPS have comparable long-term outcomes for infants in medically resource-constrained environments. Furthermore, brain volume strongly correlates with developmental and quality of life metrics, emphasizing the need to focus on optimizing brain volume growth potential in infants suffering from severe perinatal neurological insults such as infection and hydrocephalus.
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