Morbidity, Mortality and Treatment Failure after Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Infants: A Retrospective Study of 120 Cases at Bouaké University Hospital, C？te d’Ivoire

Background: Endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) is a major alternative to ventriculoperitoneal shunting in infants in sub-Saharan Africa. Its efficacy is well documented, but its own morbidity far less so. Objective: To describe the complications, their timing and severity, treatment failures, reoperations and mortality after ETV + CPC in a West African university hospital. Patients and Methods: A single-centre retrospective study of 120 consecutive infants aged 24 months or younger, operated on between 1 January 2024 and 30 April 2026. The endpoints were postoperative complications graded according to the Clavien-Dindo classification, their time to onset, treatment failure, reoperation, shunt-free survival (Kaplan-Meier) and mortality, with attribution to the procedure established case by case. Proportions are reported with exact 95% confidence intervals. Results: Seventeen patients (14.2%; 8.5 - 21.7) had at least one postoperative adverse event, amounting to 18 events—the five deaths being included as Clavien-Dindo grade V—with a median time to onset of 8 days; 77.8% occurred within 30 days, but the six secondary stoma obstructions were spread from day 21 to the eighth month. Of four cases of meningitis (3.3%), three were healthcare-associated (2.5%) and one was intercurrent and community-acquired (Neisseria meningitidis). Nine patients (7.5%) were reoperated on: six shunts and three endoscopic revisions. Shunt-free survival was 92.7% at twelve months. Mortality was 4.2% (1.4 - 9.5); a single death (0.8%) was attributable to the procedure, three were of indeterminate cause and one followed intercurrent community-acquired meningitis. Conclusion: Morbidity was moderate and mortality rarely attributable to the procedure itself. The timing argues for close monitoring during the first month and scheduled follow-up up to one year; the attribution of infections must be established case by case where community-acquired meningitis is endemic.