Hydrocephalus is the excess accumulation of cerebrospinal fluid, which circulates throughout the brain and spinal column and can cause significant damage and even death. It mostly affects children, although adults also can get hydrocephalus. Every year, thousands of babies worldwide die from untreated hydrocephalus. Neurosurgeons now have the skills and tools to deal with the condition very effectively. They have now suggested that no baby need die from this condition, once called 'water on the brain'.
In an editorial in December 2015 issue of World Neurosurgery, Loyola University Medical center neurosurgeon Dr. Vikram Prabhu, examines the issue of hydrocephalus in Uganda. Dr. Prabhu is a professor in the Department of Neurological Surgery of Loyola University Chicago Stritch School of Medicine.
‘Dr. Vikram Prabhu proposed that neurosurgeons set a precise goal for themselves - 'No child should die of untreated hydrocephalus anywhere on this planet by 2030.'’
AdvertisementHydrocephalus is very treatable with surgery. Conventional treatment involves running a shunt (a thin tube) from the brain to the abdomen and using a valve to regulate fluid draining from the brain. Excess cerebrospinal fluid is diverted to the abdominal cavity, where it is easily absorbed. But shunts are expensive and complex systems that require frequent checks and may be prone to failure. The system is difficult even in developed countries.
In developing countries, which lack the infrastructure to deal with inevitable infections and malfunctions, it is practically impossible to safely monitor and care for these devices. Neurosurgeon Benjamin Warf, developed a one-time, minimally-invasive endoscopic procedure that is safe, effective and easy to implement. (The technical term for the Warf procedure is endoscopic third ventriculostomy with choroid plexus and cauterization.)
Dr. Warf established a center in Uganda that has provided neurosurgical care to scores of children with hydrocephalus, saving many lives. Dr. Prabhu wrote, "This is one of the best paradigms of global neurosurgery, and there are lessons to be learned. The most important may be its lack of complexity; in other words, simplicity is the most powerful tool."
Healthcare in the developing world often is dictated by cost. Dr. Prabhu wrote, "The Warf procedure is an example of how sparse resources "have spurred innovative physicians to pioneer efforts that provide health care in a parsimonious manner. We have much to learn from them, and their innovations may fuel cost-effective strategies back home."
Major medical facilities are required to successfully implement complex systems that are prone to break down or not be properly implemented or updated. Dr. Prabhu wrote, "Simple solutions such as the Warf procedure can benefit areas of the world that lack such facilities."
Dr. Prabhu challenged neurosurgeons to carry on the intrepid work of Dr. Warf, who won a MacArthur Foundation 'genius grant' and now is at Harvard Medical School.
Dr. Prabhu wrote, "We should set a realistic goal with a finite timeline and pour our resources into it."
Unlike chronic illnesses that can be managed with medications but not eliminated or cured, hydrocephalus can be controlled very effectively by a surgical procedure that all neurosurgeons are familiar with and adept at. Dr. Prabhu noted that the Lancet Commission on Global Surgery estimated that 5,000 surgeries for every 100,000 people would be sufficient to cover basic surgical needs - a worthwhile goal for surgeons worldwide.
Dr. Prabhu proposed that neurosurgeons set a similar but more precise goal for themselves: 'No child should die of untreated hydrocephalus anywhere on this planet by 2030.'