Hydrocephalus in infants, particularly that with a postinfectious etiology, is a major public health burden in Sub-Saharan Africa. The authors of this study aimed to determine whether surgical treatment of infant postinfectious hydrocephalus in Uganda results in sustained, long-term brain growth and improved cognitive outcome.

The authors performed a trial at a single center in Mbale, Uganda, involving infants (age < 180 days old) with postinfectious hydrocephalus randomized to endoscopic third ventriculostomy plus choroid plexus cauterization (ETV+CPC; n = 51) or ventriculoperitoneal shunt (VPS; n = 49). After 2 years, they assessed developmental outcome with the Bayley Scales of Infant Development, Third Edition (BSID-III), and brain volume (raw and normalized for age and sex) with CT scans.

Eighty-nine infants were assessed for 2-year outcome. There were no significant differences between the two surgical treatment arms in terms of BSID-III cognitive score (p = 0.17) or brain volume (p = 0.36), so they were analyzed together. Raw brain volumes increased between baseline and 2 years (p < 0.001), but this increase occurred almost exclusively in the 1st year (p < 0.001). The fraction of patients with a normal brain volume increased from 15.2% at baseline to 50.0% at 1 year but then declined to 17.8% at 2 years. Substantial normalized brain volume loss was seen in 21.3% patients between baseline and year 2 and in 76.7% between years 1 and 2. The extent of brain growth in the 1st year was not associated with the extent of brain volume changes in the 2nd year. There were significant positive correlations between 2-year brain volume and all BSID-III scores and BSID-III changes from baseline.

In Sub-Saharan Africa, even after successful surgical treatment of infant postinfectious hydrocephalus, early posttreatment brain growth stagnates in the 2nd year. While the reasons for this finding are unclear, it further emphasizes the importance of primary infection prevention and mitigation strategies along with optimizing the child’s environment to maximize brain growth potential.

婴儿脑积水，尤其是感染后病因的婴儿脑积水，是撒哈拉以南非洲的主要公共卫生负担。本研究的作者旨在确定乌干达婴儿感染后脑积水的手术治疗是否会导致持续、长期的大脑发育和改善认知结果。

作者在乌干达姆巴莱的一个中心进行了一项试验，涉及感染后脑积水的婴儿（年龄 < 180 天）随机接受内窥镜第三脑室造口术加脉络丛烧灼术（ETV+CPC；n = 51）或脑室腹腔分流术（VPS； n = 49）。2 年后，他们使用贝利婴儿发育量表第三版 (BSID-III) 评估发育结果，并通过 CT 扫描评估脑容量（原始和针对年龄和性别的标准化）。

评估了 89 名婴儿的 2 年结局。两个手术治疗组在 BSID-III 认知评分 (p = 0.17) 或脑容量 (p = 0.36) 方面没有显着差异，因此将它们一起分析。原始脑容量在基线和 2 年之间增加（p < 0.001），但这种增加几乎只发生在第一年（p < 0.001）。脑容量正常的患者比例从基线时的 15.2% 增加到 1 年的 50.0%，然后在 2 年时下降到 17.8%。在基线和第 2 年之间，21.3% 的患者和第 1 年和第 2 年之间观察到 76.7% 的患者出现大量正常化脑容量损失。第 1 年大脑生长的程度与第 2 年脑容量变化的程度无关。

在撒哈拉以南非洲地区，即使在成功手术治疗婴儿感染后脑积水后，早期治疗后大脑生长在第 2 年仍会停滞。虽然这一发现的原因尚不清楚，但它进一步强调了初级感染预防和缓解策略以及优化儿童环境以最大限度地发挥大脑发育潜力的重要性。