- Neurosurgery Unit, Essossinam KPELAO, CHU SO, Lomé, Togo.
Essossinam Kpélao, Neurosurgery Unit, CHU SO, Lomé, Togo.
DOI:10.25259/SNI_927_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Essossinam Kpélao, Kodjo M. Hobli Ahanogbé, Komi Egu, Agbéko K Doléagbénou, Abd El Kader Moumouni, Senamé Sossoukpe, Kossi K. Ségbédji, H. EssoSolim Bakondé, Dzidoula Lawson, Bawoubadi Abaltou, Hima-Maïga Abdoulaye, Katanga A. Békéti. Children hydrocephalus in Togo: etiologies, treatment, and outcomes. 02-Dec-2022;13:560
How to cite this URL: Essossinam Kpélao, Kodjo M. Hobli Ahanogbé, Komi Egu, Agbéko K Doléagbénou, Abd El Kader Moumouni, Senamé Sossoukpe, Kossi K. Ségbédji, H. EssoSolim Bakondé, Dzidoula Lawson, Bawoubadi Abaltou, Hima-Maïga Abdoulaye, Katanga A. Békéti. Children hydrocephalus in Togo: etiologies, treatment, and outcomes. 02-Dec-2022;13:560. Available from: https://surgicalneurologyint.com/surgicalint-articles/12040/
Background: Hydrocephalus is frequent in sub-Saharan African countries. The postinfectious hydrocephalus tends to decrease. The objective of this study was to identify the etiologies and outcomes of hydrocephalus.
Methods: This was a retrospective study of hydrocephalus cases (0–15 years old) treated in the neurosurgery unit of the Sylvanus Olympio Hospital in Lomé over 10 years (2012–2021). At 1 year, the evolution distinguished in two categories: (1) Good psychomotor development: no delay in the acquisition of walking, language, and school. (2) Psychomotor delay: delay in the acquisition of walking, language, and school.
Results: We reported 305 children treated for hydrocephalus representing 1.8% of all neurosurgery unit patients and 34.2% of pediatric pathologies. There was a male predominance (60.6%). We noted second degree consanguinity in 8.5%. The positive maternal serologies were HIV (12.4%), syphilis (8.2%), and toxoplasmosis (2.6%). A malaria episode had been treated during the first trimester in 36.7% of the mothers. The main clinical sign of hydrocephalus was 91.5% of Macrocephalus. Congenital Malformafions were the most common etiologies of hydrocephalus (68.5%). Ventriculoperitoneal shunt was the main surgical method used and 16 deaths were recorded. The medium-term evolution (1 year) was evaluated in 36.1% and noted 61.8% of psychomotor retardation.
Conclusion: This study confirms the trend of the predominance of congenital causes of hydrocephalus in Africa, even if maternal infections can be involved in the development of some of them. The morbimortality of this pathology remains important, especially concerning neurocognitive outcomes.
Keywords: Etiologies, Hydrocephalus in children, Togo
Hydrocephalus is active dilation of ventricles.[
This was a retrospective study of hydrocephalus cases (0–15 years old) treated in the neurosurgery unit of the Sylvanus Olympio Hospital in Lomé over 10 years (2012–2021). The results were assessed at discharge and 1 year later. The postoperative parameters evaluated were complicated, the neurological disabilities and the psychomotor development were distinguished in two categories: (1) Good psychomotor development: no delay in the acquisition of walking, language, and school. (2) Psychomotor delay: delay in the acquisition of walking, language, and school.
A total of 305 children were treated for hydrocephalus representing 1.8% of all neurosurgery unit patients and 34.2% of pediatric pathologies. Infants were the most age range represented (88.2%). Antenatal diagnosis was made in 11 cases (3.6%). There was a male predominance of 60.6%.
The parents of children affected were mainly poor (87.2%) according to the UN definition. The average age of the mothers was 23.7 years. Their main antecedents were occasional alcoholism (52.4%), high blood tension (3.9%), diabetes (2%), and 29.2% were in single mothers. We noted second degree consanguinity in 8.5%. Pregnancy was well monitored with malaria and anemic prophylaxis in 90.8%. The positive maternal serologies were HIV (12.4%), syphilis (8.2%), and toxoplasmosis (2.6%). A malaria episode had been treated during the 1st trimester in 36.7% of the mothers. The antenatal diagnosis of hydrocephalus was made during the 3rd trimester ultrasound in 33 cases (10.8%) and 4.9% were premature.
The main clinical sign of hydrocephalus was macrocephalus (91.5%). The macrocephalus was present in 34.4% at birth (head circumference >35 cm). The average of head circumference was 56.9 cm. The average consultation time after birth was 4.7 months, with psychomotor retardation in 23.6% [
The immediate postoperative outcomes were simple in 75.4%. The main complications recorded were hyperthermia (4.3%), pressure sores (2.3%), and over drainage (3.3%). We recorded 16 deaths (staphylococcal meningitis, ventriculitis, and sepsis). During the period of study, we had 11 valve malfunctions with shunt revision (5.6% of 267 shunts)
The medium-term evolution (1 year) was evaluated in 36.1%. The results at this term are summarized in
The retardation, especially walking, affected mostly congenital hydrocephalus (malformative). Among eight hydranencephaly, only two were shown up at control. The normal neurocognition evolution concerned secondary hydrocephalus and three malformative hydrocephalus. Cranium sizes according age were normal in 21 after 1 year.
Hydrocephalus is the main pathology in pediatric neurosurgery. Our frequency does not reflect the reality because it is not all patients who are consulting. Indeed because of farness and poverty, a lot of rural population do not have access to medical facilities as reported also in another countries.[
In fact, maternal factors have a major role in development of hydrocephalus, such as stress, diabetes, alcohol, first-trimester infection, drug, and malnutrition.[
Then, the prevention of hydrocephalus for modifiable causes involves early treatment of infections in pregnant women, perinatal supplementation with folic acid, and the fight against poverty.
Although postoperative mortality is low (5.2%), the main problem is morbidity especially the cognitive deficiency. Neurocognitive deficits are well reported in children with hydrocephalous. Numerous factors such as etiology, age at onset, raised intracranial pressure, the rate of ventricular enlargement, ventricular size, the duration of hydrocephalus, coexisting pathological changes, and shunt complications have been shown to influence cognitive function.[
Neurocognitive outcome was better in secondary hydrocephalus when the cause was treated, opposite to congenital hydrocephalus with a high rate of psychomotor retardation. This fact can be explained by the early onset in congenital hydrocephalus and especially by the associated brain lesions.[
This study confirms the trend of the predominance of congenital causes of hydrocephalus in Africa, even if maternal infections can be involved in the development of some of them. The diagnosis remains late. Most patients are treated by shunt despite the availability of endoscopic ventriculocisternostomy. The morbimortality of this pathology remains important, especially concerning neurocognitive outcomes.
Patients’ consent not required as patients’ identities were not disclosed or compromised.
There are no conflicts of interest.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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