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Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda.

Abstract Postinfectious hydrocephalus in infants is a major health problem in sub-Saharan Africa. The conventional treatment is ventriculoperitoneal shunting, but surgeons are usually not immediately available to revise shunts when they fail. Endoscopic third ventriculostomy with choroid plexus cauterization (ETV-CPC) is an alternative treatment that is less subject to late failure but is also less likely than shunting to result in a reduction in ventricular size that might facilitate better brain growth and cognitive outcomes.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the new england journal of medicine
Publication Year Start




PMID- 29262276
OWN - NLM
STAT- In-Process
LR  - 20171221
IS  - 1533-4406 (Electronic)
IS  - 0028-4793 (Linking)
VI  - 377
IP  - 25
DP  - 2017 Dec 21
TI  - Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda.
PG  - 2456-2464
LID - 10.1056/NEJMoa1707568 [doi]
AB  - BACKGROUND: Postinfectious hydrocephalus in infants is a major health problem in 
      sub-Saharan Africa. The conventional treatment is ventriculoperitoneal shunting, 
      but surgeons are usually not immediately available to revise shunts when they
      fail. Endoscopic third ventriculostomy with choroid plexus cauterization
      (ETV-CPC) is an alternative treatment that is less subject to late failure but is
      also less likely than shunting to result in a reduction in ventricular size that 
      might facilitate better brain growth and cognitive outcomes. METHODS: We
      conducted a randomized trial to evaluate cognitive outcomes after ETV-CPC versus 
      ventriculoperitoneal shunting in Ugandan infants with postinfectious
      hydrocephalus. The primary outcome was the Bayley Scales of Infant Development,
      Third Edition (BSID-3), cognitive scaled score 12 months after surgery (scores
      range from 1 to 19, with higher scores indicating better performance). The
      secondary outcomes were BSID-3 motor and language scores, treatment failure
      (defined as treatment-related death or the need for repeat surgery), and brain
      volume measured on computed tomography. RESULTS: A total of 100 infants were
      enrolled; 51 were randomly assigned to undergo ETV-CPC, and 49 were assigned to
      undergo ventriculoperitoneal shunting. The median BSID-3 cognitive scores at 12
      months did not differ significantly between the treatment groups (a score of 4
      for ETV-CPC and 2 for ventriculoperitoneal shunting; Hodges-Lehmann estimated
      difference, 0; 95% confidence interval [CI], -2 to 0; P=0.35). There was no
      significant difference between the ETV-CPC group and the
      ventriculoperitoneal-shunt group in BSID-3 motor or language scores, rates of
      treatment failure (35% and 24%, respectively; hazard ratio, 0.7; 95% CI, 0.3 to
      1.5; P=0.24), or brain volume (z score, -2.4 and -2.1, respectively; estimated
      difference, 0.3; 95% CI, -0.3 to 1.0; P=0.12). CONCLUSIONS: This single-center
      study involving Ugandan infants with postinfectious hydrocephalus showed no
      significant difference between endoscopic ETV-CPC and ventriculoperitoneal
      shunting with regard to cognitive outcomes at 12 months. (Funded by the National 
      Institutes of Health; ClinicalTrials.gov number, NCT01936272 .).
FAU - Kulkarni, Abhaya V
AU  - Kulkarni AV
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Schiff, Steven J
AU  - Schiff SJ
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Mbabazi-Kabachelor, Edith
AU  - Mbabazi-Kabachelor E
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Mugamba, John
AU  - Mugamba J
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Ssenyonga, Peter
AU  - Ssenyonga P
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Donnelly, Ruth
AU  - Donnelly R
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Levenbach, Jody
AU  - Levenbach J
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Monga, Vishal
AU  - Monga V
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Peterson, Mallory
AU  - Peterson M
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - MacDonald, Michael
AU  - MacDonald M
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Cherukuri, Venkateswararao
AU  - Cherukuri V
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
FAU - Warf, Benjamin C
AU  - Warf BC
AD  - From the University of Toronto (A.V.K.) and the Hospital for Sick Children
      (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park
      (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale
      (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Children's
      Hospital, Boston (B.C.W.).
LA  - eng
SI  - ClinicalTrials.gov/NCT01936272
GR  - R21 TW009612/TW/FIC NIH HHS/United States
GR  - R01 HD085853/HD/NICHD NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - N Engl J Med
JT  - The New England journal of medicine
JID - 0255562
EDAT- 2017/12/21 06:00
MHDA- 2017/12/21 06:00
CRDT- 2017/12/21 06:00
PHST- 2017/12/21 06:00 [entrez]
PHST- 2017/12/21 06:00 [pubmed]
PHST- 2017/12/21 06:00 [medline]
AID - 10.1056/NEJMoa1707568 [doi]
PST - ppublish
SO  - N Engl J Med. 2017 Dec 21;377(25):2456-2464. doi: 10.1056/NEJMoa1707568.