Endoscopic third ventriculostomy and choroid plexus cauterization for pediatric hydrocephalus.

In March of 2000, my family and I moved to Mbale, Uganda, to help Children’s United Rehabilitation Effort International (CURE) International develop a neurosurgical hospital for children. It became immediately apparent that hydrocephalus was an enormous problem in this part of the world. Based on the numbers of infants younger than 1 year of age presenting to our hospital with hydrocephalus from the neighboring districts and the known populations and birth rate, it was conservatively estimated that in Uganda, a country with 28 million people, between 1000 and 2000 new cases of hydrocephalus occurred during infancy each year. I established that neonatal infection was the single most common etiology of hydrocephalus in this part of the world.10 Although shunting is the standard method of treating hydrocephalus, it is fraught with difficulties. For instance, the North American Shunt Design Trial failure rate was more than 40% within 3 years of the shunt placement.2 Shunt dependency is even more problematic in the setting of a country such as Uganda, where poverty, poor infrastructure, insecurity, and the scarcity of facilities and personnel prepared to deal with shunt problems create an enormous barrier to accessing appropriate care in the event of a shunt malfunction or infection. With support from CURE International and the International Federation for Spina Bifida and Hydrocephalus, I was able to investigate the efficacy of endoscopic third ventriculostomy (ETV) in this context.