The Role of the Pediatric Neurosurgeon in the Management of Hydrocephalus Internationally

Abstract

The recent emphasis on surgery as an essential yet neglected component of global health

care has drawn attention to the lack of pediatric neurosurgery in low- and middle-income

countries (LMICs). Most LMICs have very few neurosurgeons able or willing to care for

children, leaving few access to care for readily treatable conditions, like pediatric

hydrocephalus and spina bifida. Herein, we review the role of pediatric neurosurgeons to

improve hydrocephalus management and medical education in LMICs. A literature search on

global pediatric neurosurgery was performed using the Pubmed database from the year 2000

to October 5th, 2021. The majority of current pediatric neurosurgical efforts focus on the

management of hydrocephalus. Endoscopic third ventriculostomy (ETV) with or without

choroid plexus cauterization (CPC) has emerged as an effective alternative to

ventriculoperitoneal (VP) shunting for CSF diversion in LMICs. Neurosurgical programs in

LMICs are most successful when twinning is used to pair the program with an established

center in a high-income country (HIC). Multiple international pediatric neurosurgical efforts

aim to provide medical expertise, infrastructure, and surgical education to LMICs. The next

step in developing sustainable surgery programs in LMICs includes establishing local training

programs. Existing global pediatric neurosurgery programs are most successful when

partnered to an experienced center in a HIC. A lack of funding, resources, and training

programs all pose barriers to increasing the pediatric neurosurgical capacity in LMICs. Future

global neurosurgery efforts may look to other neurosurgical conditions with high burdens of

diseased in LMICs, like epilepsy.

The Role of the Pediatric Neurosurgeon in the Management of

Hydrocephalus Internationally