TITLE:
Management of Idiopathic Chronic Hydrocephalus of the Adult in Guinea: A Prospective Study in 16 Patients
AUTHORS:
Alpha Boubacar Bah, Ibrahima Sory Souare, Ibrahima Berete, Seylan Diawara, Hugues Ghislain Atatla, Aboubacar M’mah Camara, Mamadou Khaira Bah, Luc Kezely Beavogui
KEYWORDS:
Idiopathic Normal Pressure Hydrocephalus, Comorbidities, Ventriculoperitoneal Shunt, Lumbar Puncture
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.11 No.4,
October
27,
2021
ABSTRACT: Object: Incidence of Idiopathic chronic hydrocephalus of the
adult (ICHA) is increasing in Guinea due to the aging of the population. The
goal of this study was to describe its epidemiology, clinical presentation, and
surgical outcome in a low-resource medical environment. Method: Sixteen patients operated
for a probable ICHA were prospectively studied according to a uniform protocol from June 2019 to December 2020. On computerized
tomography, all operated patients had a clinical triad of gait disturbance,
incontinence, dementia associated with ventriculomegaly, and transependymal
edema. In addition, all patients underwent a single lumbar tap, improved
clinically, and were subsequently offered a shunt consisting of a simple
catheter in 37.5% and a non-adjustable high-pressure valve in 62.5%. Result: The mean age was 68.31 ± 10.4 (range 49 - 89). The sex ratio H/F was 1.67/1. Clinically, the
most frequent comorbidity was a combination of hypertension and diabetes in
56.5% of cases. The mean time to diagnosis was 8.31 ± 2.75 months
(range 3 - 14). The immediate postoperative mortality was 12.5% from a status
epilepticus and pulmonary sepsis. In addition, we observed 2 cases of chronic
subdural hematoma (12.5%) and 2 cases of shunt dysfunction (12.5%) in the first three months. The functional
outcome was good in 23% of patients at one month (N = 13), 50% at three months (N = 10), and 87.5% at six
months (N = 8). Conclusion: In
carefully selected cases, the surgical outcome of ICHA in Guinea is comparable to high-income countries. Efforts need
to be put in helping patients get covered with universal insurance and
generally promote Neurosurgery in the country to improve the quality of care.