Presentation, Management and Outcome of Pediatric Hydrocephalus in Africa: A Systematic Review and Meta-Analysis

Introduction: Hydrocephalus, a neurological disorder characterized by abnormal accumulation of cerebrospinal fluid in the ventricles of the brain, results from CSF production or absorption imbalances. The prevalence, management and outcomes of hydrocephalus in Africa is not well elucidated.

Methods: A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the PRISMA guidelines to identify articles assessing patient demographics, treatment strategies and clinical outcomes for pediatric patients in Africa with hydrocephalus.

Results: 83 retrospective/prospective studies and 42 case reports with 12,381 patients were analyzed. Male-female distribution was 1.2:1, with macrocephaly (79.3%) as the most common symptom. Hydrocephalus was predominantly congenital (44.1%). 51.8% of cases were communicating and 49.6% obstructive. Causes included infectious (18.4%), post-infectious (41.0%), and non-post-infectious (40.6%). Diagnosis was primarily through CT scan (76.1%), ultrasound (72.9%) and MRI (44.8%). Of 11,904 patients, 93.1% underwent surgery, primarily VPS (66.4%) and ETV (25.2%). Predictors of VPS were macrocephaly (77.4% vs. 96.8%, p< 0.05) and upward gaze palsy (5.56% vs. 50.2%, p< 0.05). The overall post-operative complication rate was 6.54%, including sepsis (6.28%), surgical site infections (4.32%), and CSF leaks (2.35%). ETV showed lower mortality but higher CSF leak rates. Shunt-related complications included infections (3.9%), blockages (3.19%), malfunctions (2.85%), and migration (1.53%). Operation failure occurred in 26.8% of cases, with a 6.14% shunt revision rate. Follow-up showed neurological improvement in 58.84% of patients, while 47.2% deteriorated. The overall mortality rate was 7.92%.

Conclusion : This article can be utilized by neurosurgeons to better understand the demographics, clinical characteristics, and best treatment options to provide tailored care to hydrocephalus patients.