iPATH

Introduction

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The International Program to Advance the Treatment of Hydrocephalus (iPATH) was organized as a cooperative effort of CURE International , the International Federation for Spina Bifida and Hydrocephalus, and the Karl Storz Company . The program trains and equips neurosurgeons responsible for treating Hydrocephalus in developing countries. In that practice context, shunt-dependence is dangerous for children with Hydrocephalus because of the high probability of shunt malfunctions over time that require emergency treatment. Unlike more developed countries where the existing economy, infrastructure, and health care system can readily support the emergency maintenance required for patients who are shunt-dependent, the lives of such children in less developed countries are threatened because of the lack of prompt access to neurosurgical care.

Experience in Uganda has demonstrated that, in the setting of an emerging country, the majority of children with hydrocephalus can be adequately treated using endoscopic methods. In young infants, our experience was similar to that of others, in that ETV alone was not effective in avoiding shunt dependency for the majority. But we demonstrated that choroid plexus cauterization in combination with endoscopic third ventriculostomy (ETV/CPC) was extremely effective . The ETV/CPC technique requires the use of a flexible fiberoptic endoscope in order to access the choroid plexus throughout both lateral ventricles.

The CURE Children's Hospital in Mbale, Uganda, provides the high volume of patients necessary to master these techniques in a relatively short time. In 2 months, a trainee can expect hands-on training in 50 to 100 ETV/CPC procedures. The program is directed by Professor Benjamin Warf, who developed the technique. For neurosurgeons from less developed countries, CURE and IF will work with the trainee to acquire funding to help support their training as well as to help provide the necessary endoscopy equipment for their home institution.

The goal of iPATH is to develop a network of hospitals throughout the world that are competent to offer this treatment option and thus avoid the dangerous problem of shunt -dependence, especially for children in economically depressed regions. An additional goal is to develop a database of information through this network in order to improve on our ability to treat this common condition.

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