PMID- 34243157
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230619
IS  - 1933-0715 (Electronic)
IS  - 1933-0707 (Print)
IS  - 1933-0707 (Linking)
VI  - 28
IP  - 3
DP  - 2021 Jul 9
TI  - Brain growth after surgical treatment for infant postinfectious hydrocephalus in 
      Sub-Saharan Africa: 2-year results of a randomized trial.
PG  - 326-334
LID - 10.3171/2021.2.PEDS20949 [doi]
AB  - OBJECTIVE: Hydrocephalus in infants, particularly that with a postinfectious 
      etiology, is a major public health burden in Sub-Saharan Africa. The authors of 
      this study aimed to determine whether surgical treatment of infant postinfectious 
      hydrocephalus in Uganda results in sustained, long-term brain growth and improved 
      cognitive outcome. METHODS: The authors performed a trial at a single center in 
      Mbale, Uganda, involving infants (age < 180 days old) with postinfectious 
      hydrocephalus randomized to endoscopic third ventriculostomy plus choroid plexus 
      cauterization (ETV+CPC; n = 51) or ventriculoperitoneal shunt (VPS; n = 49). 
      After 2 years, they assessed developmental outcome with the Bayley Scales of 
      Infant Development, Third Edition (BSID-III), and brain volume (raw and 
      normalized for age and sex) with CT scans. RESULTS: Eighty-nine infants were 
      assessed for 2-year outcome. There were no significant differences between the 
      two surgical treatment arms in terms of BSID-III cognitive score (p = 0.17) or 
      brain volume (p = 0.36), so they were analyzed together. Raw brain volumes 
      increased between baseline and 2 years (p < 0.001), but this increase occurred 
      almost exclusively in the 1st year (p < 0.001). The fraction of patients with a 
      normal brain volume increased from 15.2% at baseline to 50.0% at 1 year but then 
      declined to 17.8% at 2 years. Substantial normalized brain volume loss was seen 
      in 21.3% patients between baseline and year 2 and in 76.7% between years 1 and 2. 
      The extent of brain growth in the 1st year was not associated with the extent of 
      brain volume changes in the 2nd year. There were significant positive 
      correlations between 2-year brain volume and all BSID-III scores and BSID-III 
      changes from baseline. CONCLUSIONS: In Sub-Saharan Africa, even after successful 
      surgical treatment of infant postinfectious hydrocephalus, early posttreatment 
      brain growth stagnates in the 2nd year. While the reasons for this finding are 
      unclear, it further emphasizes the importance of primary infection prevention and 
      mitigation strategies along with optimizing the child's environment to maximize 
      brain growth potential.
FAU - Schiff, Steven J
AU  - Schiff SJ
AD  - 1Center for Neural Engineering.
AD  - Departments of6Neurosurgery.
AD  - 7Engineering Science and Mechanics, and.
AD  - 8Physics, The Pennsylvania State University, State College, Pennsylvania.
FAU - Kulkarni, Abhaya V
AU  - Kulkarni AV
AD  - Departments of2Neurosurgery and.
FAU - Mbabazi-Kabachelor, Edith
AU  - Mbabazi-Kabachelor E
AD  - 4CURE Children's Hospital of Uganda, Mbale, Uganda; and.
FAU - Mugamba, John
AU  - Mugamba J
AD  - 4CURE Children's Hospital of Uganda, Mbale, Uganda; and.
FAU - Ssenyonga, Peter
AU  - Ssenyonga P
AD  - 4CURE Children's Hospital of Uganda, Mbale, Uganda; and.
FAU - Donnelly, Ruth
AU  - Donnelly R
AD  - 3Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.
FAU - Levenbach, Jody
AU  - Levenbach J
AD  - 3Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.
FAU - Monga, Vishal
AU  - Monga V
AD  - 1Center for Neural Engineering.
FAU - Peterson, Mallory
AU  - Peterson M
AD  - 1Center for Neural Engineering.
FAU - Cherukuri, Venkateswararao
AU  - Cherukuri V
AD  - 1Center for Neural Engineering.
FAU - Warf, Benjamin C
AU  - Warf BC
AD  - 5Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.
LA  - eng
GR  - F30 HD102120/HD/NICHD NIH HHS/United States
GR  - R01 AI145057/AI/NIAID NIH HHS/United States
GR  - R01 HD085853/HD/NICHD NIH HHS/United States
GR  - R21 TW009612/TW/FIC NIH HHS/United States
PT  - Journal Article
DEP - 20210709
PL  - United States
TA  - J Neurosurg Pediatr
JT  - Journal of neurosurgery. Pediatrics
JID - 101463759
SB  - IM
PMC - PMC8742836
MID - NIHMS1742806
OTO - NOTNLM
OT  - ETV+CPC
OT  - brain growth
OT  - choroid plexus cauterization
OT  - endoscopic third ventriculostomy
OT  - hydrocephalus
OT  - neurocognitive outcome
OT  - ventriculoperitoneal shunt
COIS- Disclosures The authors report no conflict of interest concerning the materials 
      or methods used in this study or the findings specified in this paper.
EDAT- 2021/07/10 06:00
MHDA- 2021/07/10 06:01
PMCR- 2023/01/09
CRDT- 2021/07/09 20:35
PHST- 2020/12/04 00:00 [received]
PHST- 2021/02/17 00:00 [accepted]
PHST- 2021/07/10 06:01 [medline]
PHST- 2021/07/10 06:00 [pubmed]
PHST- 2021/07/09 20:35 [entrez]
PHST- 2023/01/09 00:00 [pmc-release]
AID - 2021.2.PEDS20949 [pii]
AID - 10.3171/2021.2.PEDS20949 [doi]
PST - epublish
SO  - J Neurosurg Pediatr. 2021 Jul 9;28(3):326-334. doi: 10.3171/2021.2.PEDS20949.