Journal of Pediatric Growth & Health Perspectives

Abstract

Introduction: Hydrocephalus is a multifactorial condition with various causes and is common in pediatric practice. No study has previously examined the profile of children admitted for hydrocephalus. We therefore decided to conduct this study to evaluate the management of hydrocephalus in children aged 0 to 18 years in the neurosurgery department of the Ziguinchor Regional Hospital Centre.

Materials and Methods: This was a retrospective study (covering the period from 1 July 2019 to 31 December 2020), prospective (from 1 January 2021 to 30 March 2023), descriptive, cross-sectional study conducted over a period of 45 months (3 years and 8 months), including children aged 0 to under 18 years admitted for hydrocephalus. We collected data from clinical observation forms and registers. Data analysis and statistical analysis were performed using Sphynx and Excel 2016 software.

Results: We identified 51 cases of hydrocephalus with a sex ratio of 1.125. Its incidence is 1.01%, and the average annual rate is 13.88 cases per year, corresponding to an average monthly rate of 1.13 cases. The mean age was 22 months. A history of consanguinity was found in 20 cases (39.2%). The diagnosis was made antenatally in 17.7% of cases. Postnatally, the diagnosis was confirmed on the basis of clinical findings, brain CT scans and transfontanellar ultrasound (TFU). The clinical signs were dominated by macrocephaly (86.3%), psychomotor developmental delay, intracranial hypertension and sunset gaze. Hydrocephalus was congenital in 72.5% of cases, with Sylvius aqueduct stenosis being the most common cause at 59.4%, followed by Dandy-Walker malformation (16.2%) and spina bifida (13.4%). The cause was identified in 19.6% of cases, with tumor-related hydrocephalus accounting for 50%, followed by post-meningitis hydrocephalus in 30% of cases and cases of undetermined cause in 7.8% of cases. Thirty-four (34) children, representing 66.7% of cases, underwent surgery consisting of a ventriculoperitoneal shunt (VPS). An external shunt was performed in only one patient and subsequently converted to a VPS following treatment for meningitis. The 17 patients who did not undergo surgery are broken down as follows: 10 deaths prior to surgery, 3 cases of discharge against medical advice, and 4 cases ineligible for surgery. Post-operative complications were mechanical in nature (23% of the 34 patients who underwent surgery) and infectious, notably including 5 cases of post-operative meningitis. Long-term follow-up revealed 9 cases of intellectual disability with behavioral disorders, 2 cases of bilateral blindness and 6 cases of epileptic seizures.

Conclusion: Hydrocephalus is one of the most common neurological conditions in pediatric neurosurgery. It affects not only the functional prognosis but also the patient’s survival, hence the need for a rapid and appropriate diagnosis and management.