Ntonde Usher Kirungi kirungiusher@gmail.com Makerere University's 1st African Biomedical Scientists' Conference 2nd March 2019 at Kampala Kolping Hotel

1. Hydrocephalus
NTONDE USHER KIRUNGI
AMODOI RONALD
GUME VICTOR
OCAN SAMUEL
Mbarara University of Science and Technology

2. Hydrocephalus
• A condition in which there is excessive accumulation of cerebrospinal
fluid in the brain ventricles thus increasing intracranial pressure.
• It is common in infants with an observable sign of a swollen head.
• Signs of hydrocephalus include bulging fontanel, rapid increase in
head circumference, eyes that are fixed downwards, excessive
sleepiness.

3. Have you ever seen a child with
hydrocephalus?

4. Children with hydrocephalus

5. Hydrocephalus can result from;
• A genetic abnormality
• Pregnancy infections for example rubella
• Decreased absorption of CSF by blood vessels
• Excessive CSF production
• Abnormal CSF flow blockages
• Bleeding inside the brain, blood clots
• Meningitis
• Brain tumours
• Head injury

6. Hydrocephalus
• World hydrocephalus day- 25th October
• State minister for primary health care and neurologist, Hon. Dr. Moriku
Joyce Kaducu said that out of every 1000 births, 3-5 children are born with
hydrocephalus condition. (October 24th 2018)
• Families do not seek needed treatment because of the perceptions and
stigma and high cost of investigations, neuro surgeries and long term
rehabilitation.
• Hospital charges between shs 750,000 to shs 950,000 for the first
treatment depending on the nature of operation carried out.
• The burden of infant hydrocephalus in East Africa is significant, with more
than 6000 new cases estimated per year.
• With about 1 neurosurgeon per 10,000,000 people in East Africa, initial
treatment for hydrocephalus is often unavailable.

7. Hydrocephalus in Uganda
• It is estimated that around 1000 to 1400 children are born with
hydrocephalus condition annually. According to data from the health
ministry, hydrocephalus is on the increase in Uganda.
• It is estimated that the number of children born with hydrocephalus
has increased by 600 from 2011 to 2018.
• “when families get these children, the men always leave. They blame
the women and leave her to look after the child as if it is her fault,”
Ruth Nalugya, the President Spina bifida and hydrocephalus
Association of Uganda- SHAU, also a mother to a child born with both
defects, describes the two conditions as life consuming.

8. Treatment of hydrocephalus
• The most common and effective treatment of hydrocephalus is the
shunt system which has been used for over 50 years.
• No treatment of hydrocephalus can cause brain damage and death.

9. The hydrocephalus shunt
• It relieves pressure by draining excess cerebrospinal fluid from the
cerebral ventricles located in the brain.
• It consists of a proximal catheter, valve and distal catheter.
• Hydrocephalus shunts are manufactured solely from medical grade
silicone owing to its chemical stability, minimal biological reactivity,
low toxicity and non carcinogenicity.

10. The hydrocephalus shunt

11. Common shunt problems
Infections
• These are caused by bacteria entering the incision from the skin using
the insertion procedure.
• Bacteria also adhere to the inner and outer surfaces of a shunt tubing
and colonize leading to biofilm development.
• Bacteria adhesion is aided by microscopic surface irregularities as well
as surface hydrophobicity.
• However, bacteria adhesion to the outer surface can be cleaned by
the cellular immune system but inner surface is isolated from immune
system providing environment for bacteria colonization.

12. Other shunt problems
• Shunt obstruction due to tissue ingrowth or blood clots within the
tubing.
The proximal catheter is multi- perforated in order to enable CSF to
pass through hence aiding tissue ingrowth
• Mechanical failure, kinks in the shunt tubing, leaks
• Excess drainage of cerebrospinal fluid

13. How to prevent bacteria colonization and
adhesion on shunt material
• Surface modification with hydrophilic polymer, heparin or anti
microbial agents.
Hydrophilic surfaces reduce bacteria adhesion.
• Impregnation of material with anti microbial agents forexample
Rifampin and clindamycin
• Use of hydrogel coated catheters, they have a hydrophilic surface that
impedes bacterial adherence.
• Use of silver coated catheters- silver releases cationswhich are toxic
to bacteria.

14. Impregnation and antimicrobial coating
• Impregnation of silicone catheter tubing has been suggested to be
superior over surface coating because it allows sustained release of
antimicrobial agents and protects both the inner and outer surfaces
of the catheter.
• Impregnated silicone elastomer kills bacteria already attached and
limits further colonization and spreading.
• Coating reduces bacteria adhesion but not colonization

15. Conclusion
• The CSF shunt system is a life saving device however it has a high
failure rate due to infection and obstruction.
• There is need to apply knowledge of biomaterials to prolong shunt
lifespan through improving and modifying shunt materials by
impregnation of catheter with antibiotics and furthermore prolonging
anti microbial properties by incorporating silver and copper that
release their cations which are toxic to bacteria.

16. References
• Biomaterials for the central nervous system by Yinghui Zhong and
Ravi V Bellamkonda
• Bayston. (2004). Mode of action of antimicrobial biomaterial for use
in hydrocephalus shunt.
• Cagavi B. (2004). Effect of hydrophilic coating on microorganism
colonization in silicone tubing, hydromer coated catheters to prevent
shunt infection.
• Children, C. Africa, E., & Neurosurg, J. (2005). Hydrocephalus in
Uganda: the predominance of infectios origin with endoscopic third
ventriculostomy, 102 (Pediatrics 1), 1-15.