In sub-Saharan Africa, a quarter of a million babies suffer from a deadly condition: hydrocephalus. Often called “water on the brain,” hydrocephalus occurs when cerebrospinal fluid gets trapped in the brain. The excess fluid causes the skull to swell, eventually leading to brain damage—and ultimately death. When hydrocephalus goes untreated, most children will die before the age of two. 

Shortcomings of the Traditional Treatment Model

The traditional treatment for hydrocephalus was a process known as “shunting”. This means that doctors would insert a tube into the infant’s brain to drain excess cerebrospinal fluid. But shunts often malfunction. In fact, nearly half of all pediatric shunts fail within the first two years of placement.

A failed shunt is a dire emergency. To save the child, immediate neurosurgery is generally required. Shunting remains common in the U.S. because such pediatric neurosurgery is largely accessible.

But in many other regions of the world, it is not a sustainable option. In Uganda, many families live days travel away from hospitals that perform neurosurgery. In the case of a shunt malfunction, they don’t have the resources to get to a hospital quickly enough to save their children.

US Doctor Pioneers Innovative Treatment

Working at a hospital in Mbale, Uganda, Dr. Benjamin Warf pioneered a new––and permanent––hydrocephalus treatment. He combined two pre-existing techniques: endoscopic third ventriculostomy (ETV) and choroid plexus cauterization (CPC). Together, the treatment is known as ETV/CPC.

To allow fluid to drain properly, doctors create a small opening in the third ventricle of the child’s brain––hence the term “third ventriculostomy”. Then they use a wire carrying low electrical current to burn the region of the brain known as the “choroid plexus”. This region is responsible for producing cerebrospinal fluid; so when doctors burn it, it produces less fluid.

Studies have shown that ETV/CPC entirely prevents the need for a shunt in most infants. And no shunt means fewer trips to the emergency room.

However, there was doubt as to whether ETV/CVC would be as effective at reducing water volume as the old shunting method. So Warf and colleagues tested the two methods on nearly 100 Ugandan children. Between the two methods, they detected no difference in brain volume or general cognitive ability one year later.

CURE Hospital Takes Holistic Approach to treatment

Warf innovated this life-saving treatment while working at a charitable hospital run by the nonprofit CURE International. The CURE Hospital in Mbale, Uganda is now the global leader for ETV/CPC and Africa’s leader in treating pediatric neurological conditions.

The CURE team takes a holistic approach toward treating hydrocephalus in Uganda. They have professional counselors that focus on the entire family’s emotional and spiritual needs. And they’ve even opened mobile clinics that make hydrocephalus treatment accessible in remote regions that have been historically forgotten.

Across the developing world, CURE hospitals have saved over 12,000 children with hydrocephalus and spina bifida.

With the global health conversation mostly focused on the communicable disease front, the importance of surgical interventions often goes by the wayside. The work of Warf and colleagues has lasting implications for the importance––and effectiveness––of investing in surgery in developing countries.

Photo: Flickr