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Hydrocephalus in developing countries

Dr Upio in Congo

In cooperation with Dr. M Oneko, c/o KCMC Paediatric Department, and Dr. M. Nicol CCBRT, Dar es Salaam, IF has produced a set of guidelines on the treatment of hydrocephalus in developing countries and uses these guidelines in its projects.

Hydrocephalus is most commonly treated by placement of a ventriculoperitoneal shunt (VP shunt). Shunts may be accompanied by a number of problems. They are prone to infection, especially within the first 3 months after operation. Shunt infections are life threatening and expensive and treatment is time-consuming. VP shunts are also prone to malfunction. One recent large multi-institutional study found that 40% of patients required a shunt revision within 2 years of initial shunt placement. Given a lifetime of shunt dependency, these problems are especially dangerous when access to competent care is difficult.

An alternative treatment is endoscopic third ventriculostomy (ETV). This treatment is minimally invasive. It also avoids infection, shunt dependency, the potential for shunt malfunction, and the cost of a shunt. ETV perforates the lower section of the third ventricle, which allows Cerebro-spinal fluid (CSF) to escape from the ventricles into the subarachnoid spaces, from which it is subsequently absorbed. If the hydrocephalus is caused by an obstruction to CSF flow within the ventricles, obstruction to the normal CSF outflow from openings in the IVth ventricle, or obstruction to CSF flow within the basal subarachnoid spaces around the fourth ventricle, the ETV will bypass any of these obstructions and relieve the problem if the normal CSF absorptive mechanisms are functioning adequately. 

Policy individual requests for help
IF does not have a policy of supporting individual requests.
For individual support in developing countries IF collaborates with the LilianeFoundation.

When a child with hydrocephalus arrives at a project, a medical consultation at a health centre is always advisable: 

  • For children under the age of 2 it is always important that they are examined by a doctor. Children over the age of two with symptoms of so-called overpressure need to be seen by a doctor as soon as possible.
  • Older children or young people with a stabilised hydrocephalus do not have to go to a doctor in the short term, unless there are problems.
  • Even if a surgical intervention (with a shunt) is not needed, other help can often lead to better care for the child and an improvement of the quality of life of the child.

Prior to a medical consultation, the following steps should be taken: 

  • Measure the head of the child (see special leaflet for hydrocephalus). 
  • Train the mother of the child how to measure the child's head and how to interpret changes and symptoms.

If the doctor advises a shunt is necessary, the decision will be made on the most appropriate location to carry out the procedure, bearing in mind where the child lives and the distance to the hospital.

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