Pi­o­neer­ing pro­ce­dure in Lon­don of­fers hope to Kuwaiti chil­dren

Kuwait Times - - HEALTH & SCIENCE -

Kuwait chil­dren with hy­dro­cephalus have been of­fered new hope through a revo­lu­tion­ary tech­nique, ETV-CPC, which re­duces the risk of fluid pro­duc­tion in the brain, and of­ten means less fol­low-ups for pa­tients com­pared to the tra­di­tional brain shunt pro­ce­dure. The pro­ce­dure, now avail­able to Kuwaiti pa­tients treated at Great Or­mond Street Hospi­tal (GOSH), is set to im­prove the lives of thou­sands of ba­bies with hy­dro­cephalus, one of the most com­mon birth de­fects. Hy­dro­cephalus is a con­di­tion where the pa­tient has a build-up of fluid in the brain, this causes an ab­nor­mal widen­ing of spa­ces in the brain.

The widen­ing can cause harm­ful and pos­si­bly fa­tal pres­sure in the brain. An un­usu­ally large head is the main sign of con­gen­i­tal hy­dro­cephalus. The con­di­tion is com­mon in ba­bies who have spina-bi­fida and chil­dren who get infections such as menin­gi­tis in their early child­hood. One to two of ev­ery 1,000 ba­bies are born with hy­dro­cephalus, which makes it as com­mon as Down’s syn­drome and more com­mon than spina bi­fida or brain tu­mors. A study con­ducted in Abu Dhabi over a pe­riod of three years showed that 16.6 per 1000 births have se­vere mal­for­ma­tion with 72 per­cent of new­borns be­ing Arab. GOSH per­forms ap­prox­i­mately 400 hy­dro­cephalus surg­eries ev­ery year, of which 10-20 cases are pa­tients from the Mid­dle East.

Con­sul­tant pe­di­atric neu­ro­sur­geon, Dr Greg James, from GOSH ex­plains that there are no med­i­cal ther­a­pies avail­able to treat hy­dro­cephalus and the only op­tions are sur­gi­cal. “The tra­di­tional way to treat hy­dro­cephalus is with a shunt. While it is still a very good oper­a­tion that is con­ducted com­monly, it leaves the pa­tient with a per­ma­nent tube in the body to al­low for the drain­ing of the fluid. The lim­i­ta­tions with any tube or me­chan­i­cal de­vice is that it can snap, it can get blocked, it can get in­fected and cause prob­lems. ETV-CPC gives the pa­tient the chance to avoid the life­long bur­den of care that comes with hav­ing a shunt,” Dr James added.

ETV-CPC is a well-estab­lished pro­ce­dure that was orig­i­nally de­signed to cre­ate a cost-ef­fec­tive and per­ma­nent so­lu­tion for chil­dren in Africa as it re­sults in less fol­low-ups. “The pro­ce­dure is well-tol­er­ated and only takes an hour or two. The child can then go home within a day or two of the oper­a­tion. There is re­as­sur­ance for Mid­dle East­ern fam­i­lies that with ETV-CPC, there is less chance that they will need to ac­cess spe­cial­ist care very quickly. Un­like with a shunt, for ex­am­ple, which can get blocked and then needs to be treated im­me­di­ately by a spe­cial­ist neu­ro­sur­geon - which is not al­ways pos­si­ble to ac­cess lo­cally,” he says.

Dr James points out that ev­ery case is dif­fer­ent and it is im­por­tant to choose the right oper­a­tion for the child. “ETV-CPC is less likely to work for chil­dren who need an im­me­di­ate so­lu­tion and some­times the child will have to have to come back and have a shunt. But if ETV-CPC works, it is a re­lief from a longlife of fol­low-ups. We need to have a dis­cus­sion as part of a mul­ti­dis­ci­plinary team and with the fam­ily to make the right choice for the pa­tient,” he ex­plains. Dr James es­ti­mated that the ma­jor­ity of cases GOSH sees are still un­der­go­ing shunt surg­eries, how­ever half of them are good can­di­dates for ETVCPC. Dr James be­lieves that this oper­a­tion, which is now avail­able at GOSH, of­fers in­ter­na­tional pa­tients from Kuwait the chance to have a bet­ter qual­ity of life and lim­its the life-long bur­den of care which of­ten comes with hav­ing the tra­di­tional shunt pro­ce­dure.

Dr Greg James

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