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Improved Surgical Technique Cures Hydrocephalus In Young Children

In Uganda, doctors report widespread successful surgery for a childhood disease that if left untreated can lead to mental retardation, blindness and often death. Their findings appear in the January issue of the Journal of Neurosurgery.

It’s called Hydrocephalus or, more commonly, water on the brain. It’s not known just how many African children develop the disease shortly after birth. But it’s estimated two thousand children a year develop the illness in Uganda alone.

Dr. Benjamin Warf is medical director and chief of surgery at CURE International’s Children’s hospital in Mbale, Uganda.

He says, "It’s a condition where the fluid that’s normally produced inside the brain and normally makes its way out along certain pathways gets blocked in the baby’s developing brain. And when that happens the fluid builds up and puts pressure on the brain of the baby."

That can lead to numerous problems, including some obvious physical changes.

"The most obvious one to the parents is that the head grows too fast and ultimately becomes quite large. But what also is happening is that the developing brain is progressively damaged. And it leads ultimately to mental retardation and spasticity and often blindness," he says.

He says if it’s not treated, about half the babies will die by the age of two. But, if it’s caught early, he says, “The entire process can be reversed.” That means the child can be expected to develop normally.

"Since the 1960’s and onward, it’s been most commonly treated by placing a tube in the brain that runs underneath the skin and down into the abdomen. And that allows the fluid to drain out of the brain and into the abdominal cavity. And that device is called a shunt. And that’s been the most common way of treating the disease," he says.

But Dr. Warf says about 50 percent of the time, the shunts will malfunction or fail at least once. That’s why he and his colleagues are promoting the use of a different technique that’s not as well known.

"It’s a procedure called the Endoscopic Third Ventriculostomy. We call it the ETV for short. And people have been doing this, well, off and on for many, many years. But in the last decade or so it’s become more commonly done because of developments in technology," he says.

In the ETV procedure, doctors do not implant a shunt. Instead, they insert a tiny, flexible scope inside the fluid cavities of the brain. The scope also contains a camera that sends a picture to a video screen in the operating room.

"The procedure simply consists in going down into the fluid cavities and making a new opening for the blocked fluid to be able to get out of the brain – and escape into the pathways where it normally is absorbed," he says.

ETV is not just a treatment; it is a cure.

The research in Mbale, Uganda, has led doctors to believe the cause of Hydrocephalus is an infection, probably meningitis, occuring within one month of birth.

Dr. Warf says, "There are certain conditions here that predispose the child to developing this. One of them is that about 60 percent of the births here in Uganda occur at home without any sort of skilled attendant, not even a midwife. And birth under those circumstances raises the risk of certain obstetrical complications that predispose a child to infection early in life."

He says infection being the cause of Hydrocephalus in developing countries had not been previously reported.

He says the next step is to teach other doctors in Africa how to perform ETV. CURE International operates and equips many teaching hospitals in Africa and elsewhere.

Research on the procedure appears in the January issue of the Journal of Neurosurgery.