1024 The Influence of Remote Presence Training and Mentorship (RPTM) on Surgical Indications and Operative Decision-Making for Pediatric Hydrocephalus in Resource-Limited Settings

INTRODUCTION: The management of pediatric hydrocephalus in LMICs is complicated by a heavy burden of disease, inadequate surgical infrastructure, and limited exposure to endoscopic treatment, leading to non-standardized management and shunt-related morbidity. METHODS: A brief survey was administered to recent graduates of the NeuroKids pediatric hydrocephalus training program. Questions sought to understand surgeons’ management of pediatric hydrocephalus before and after their NeuroKids training. RESULTS: Six fellows from four countries (Egypt (2), Brazil (2), Nigeria, Kenya) participated in the survey. Fellows evaluated a median of 18 (IQR: 12-24) new hydrocephalus patients each month. Before NeuroKids training, four fellows reported that some patients (16.5%) with benign ventriculomegaly were unnecessarily treated for hydrocephalus at their own or referring institutions. Prior to NeuroKids training, 93% (IQR: 83%-95%) of new hydrocephalus patients received a VP shunt (ETV for 8%). Fellows consulted NeuroKids faculty for pre-operative decision-making support in 13% of cases and for intraoperative decision-making in 15% of cases; in all instances (100%), fellows found this support helpful. Following RPTM, there was a significant increase in the proportion of ETVs performed (75% vs. 8%) and fewer VP shunts placed (25% vs. 93%) (both p=0.035). After training, all fellows (100%) reported improved knowledge and capacity to manage hydrocephalus and stated 75% of their patients were treated differently and better as a result of the NeuroKids mentorship model. Such improvements included a better understanding of treatment indications (83%), improved technical skills (66%), expanded age criteria for hydrocephalus treatment (50%), and institutional practice changes (50%), among others. CONCLUSIONS: NeuroKids RPTM program markedly improved surgeons’ ability to manage pediatric hydrocephalus, leading to fewer unnecessary treatments and a significant increase in endoscopic management across four LMIC centers.