Global Training for Hydrocephalus Care: Reducing Shunt Dependence Through Innovation
Annually, nearly half a million babies will be affected by hydrocephalus, most from LMICs. Left untreated, the risk of death or disability is significant, and the economic burden of shunt maintenance is high. The treatment for hydrocephalus has long been placement of a ventriculoperitoneal (VP) shunt. More than 40% of those shunts will fail in the first two years, up to 80% will fail by 10 years. The complications of shunt malfunction and infection are usually manageable with good access to care, but in parts of the world where access is out of reach, shunt-dependence is an ongoing life-threatening condition. One solution to the problem of hydrocephalus and shunt dependence is endoscopic third ventriculostomy and choroid plexus cauterization. This is a minimally invasive procedure and involves creating an opening in the floor of the third ventricle combined with a procedure the reduces choroid plexus in some of the ventricles. This minimally invasive procedure avoids shunt-dependence in 2/3 babies with any type of hydrocephalus and 3/4 of those with Spina Bifida. Developed in Uganda by Dr. Benjamin Warf and first reported in 2005, ETV/CPC is available in North America, but is relatively absent on the global stage. Clinical data suggests that the ETV/CPC is the best-practice treatment for infant hydrocephalus in both high and low resource settings.
For many years ETV/CPC training required that the surgeons needed to move to a specific locations for a period of time for training. During the pandemic, however, more mobile ways were needed to train surgeons and their staff on this procedure. To achieve this goal the nonprofit NeuroKids was started. By incorporating state of the art equipment and methods for remote and simulated learning, NeuroKids was able to remove the barriers and was able to continue building collaborative partnerships and conduct training. These measures reduced the need for long-term travel and reduced the cost of training.
The first site was piloted for this method of training took place in Cairo, Egypt at Ain Shams University in February/March 2022 where their neurosurgeon and support staff were trained on ETV/CPC. Nursing staff and post-operative care are supported by nurse practitioner Ashley Birch MSN, RN, CPNP. Virtual training continued for a year after the initial launch. This has now become a staple of their practice and the goal is to have their surgeon travel and train others in ETV/CPC within Egypt and Africa. The second site and training took place in Sao Paolo, Brazil in October 2022 and the third site was Rabat, Morocco in March 2023. Virtual training in Morocco and Brazil and data collection at all sites is still continuing.
Hybrid models of partnership are currently in Kampala, Uganda and Luanda, Angola as well as Medan, Indonesia. Looking ahead, future sites of work include: Amman, Jordan, Mombasa, Kenya, Brasila, Brazil, and Karachi, Pakistan with continued training of surgeons in ETV/CPC, prevention and causes of both hydrocephalus and spina bifida as well as research and implementation of optimal follow-up for children with these conditions in resource limited settings.
To learn more, please visit: https://neurokids.org/neurokids-annual-report-2022/
