My research efforts have focused primarily on hydrocephalus in the developing world and in the United States, defining, validating, and reproducing a novel, low-cost method for treating this condition.
During my time as a neurosurgeon in Uganda, I was the first to identify neonatal infection as the most common cause of hydrocephalus in East Africa. I uncovered a correlation between the rainfall cycle and these infections. I pioneered and tested an alternative to shunts for this population, combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC). Much of my research has focused on outcomes for this surgery.
Our work was the first to demonstrate equivalence in early childhood development between ETV/CPC and shunt treatment and the first to show the effect of previous ETV or CPC on subsequent shunt function. My research analyzed the disease burden and economic impact for infant hydrocephalus in sub-Saharan Africa, and provided a detailed cost-benefit analysis of its treatment -- among the first studies to demonstrate cost-effectiveness for any surgical procedure in a setting with limited resources.
Clinical outcomes have been an important part of my research. I documented the 5-year survival rates and functional outcomes for Ugandan infants treated for myelomeningocele and for post-infectious-hydrocephalus. I have also reported equivalent outcomes between an inexpensive Indian shunt and an American shunt costing 20 times more.
In 2012, I was awarded a grant from the NIH to carry out a prospective randomized trial of developmental and brain volume outcomes for shunt placement versus ETV/CPC in Ugandan infants with post-infectious hydrocephalus. This work has now received additional NIH funding for its completion and extension through a grant that began in August 2015.
By invitation, I have presented our work at the CDC as well as the NIH. I have testified before the House Subcommittee on Africa, Global Health, and Human Rights, which resulted in the introduction of the International Hydrocephalus Treatment and Training Act (HR 3525) into the House of Representatives, and the subsequent introduction of HR 1468, the “Global Brain Health Act of 2015”.
My research, teaching, and leadership in both Africa and North America continue to inform and benefit one another with the ultimate goal of improving access to optimal, evidence-based, and sustainable treatment for children with hydrocephalus and spina bifida everywhere. Some key publications in these areas include:
Warf BC. Hydrocephalus in Uganda: predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg (Pediatrics 1), 102:1-15, 2005.
Warf BC. Comparison of One - Year Outcomes for the ChaabraTM and Codman Hakim Micro PrecisionTM shunt systems in Uganda: A Prospective Study in 195 Children. J Neurosurg (Pediatrics 4), 102:358-362, 2005.
Warf BC. Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. J Neurosurg (6 Suppl Pediatrics), 103:475-481, 2005.
Warf BC, Campbell JW. Combined endoscopic third ventriculostomy and choroid plexus cauterization(ETV/CPC) as primary treatment of hydrocephalus for infants with myelomeningocele: Long-term results of a prospective intention to treat study in 115 African infants. J Neurosurg Pediatrics, 2:310-316, 2008.
Warf BC, Ondoma S, Kulkarni A, Donnelly R, Ampeire M, Akona J, Kabachelor C, Mulondo R, Nsubuga B. Neurocognitive outcome and ventricular volume in myelomeningocele children treated for hydrocephalus in Uganda. J Neurosurg Pediatrics 4:564-570, 2009.
Warf BC, Mugamba J, Kulkarni A. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. J Neurosurg Pediatrics 5:143-148, 2010
Warf BC, Kulkarni A. Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children. J Neurosurg Pediatrics 5:204-209, 2010
Li L, Padhi A, Ranjeva SL, Donaldson SC, Warf B, Mugamba J, Johnson J, Opio Z, Jayarao B, Kapur V, Poss M, Schiff S. Association of Bacteria with Hydrocephalus in Ugandan Infants. J Neurosurg Pediatrics 7:73-87, 2011
Warf BC, Stagno V, Mugamba J. Encephalocele in Uganda: Ethnic variation in lesion location, endoscopic management of hydrocephalus, and survival in 110 consecutive children. J Neurosurg Pediatrics 7:88-93, 2011
Warf BC, Wright EJ, Kulkarni AV. Factors affecting survival of infants with myelomeningocele in southeastern Uganda. J Neurosurg Pediatrics 7:127-133, 2011.
Warf BC, Dewan M, Mugamba J. Management of Dandy-Walker Complex-associated infant hydrocephalus by combined endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC). J Neurosurg Pediatrics 8:377-383, 2011
Warf BC, Alkire BC, Bhai S, Hughes C, Schiff S, Vincent J, Meara, JG. The costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa. J Neurosurg Pediatrics 8:509-521, 2011
Warf BC, Dagi AR, Nsbuga B, Schiff SJ. Five year survival and outcome of treatment for post-infectious hydrocephalus in Ugandan infants. J Neurosurg Pediatrics 8:502-508, 2011
Warf BC, Bhai S, Kulkarni AV, Mugamba J. Shunt survival after failed endoscopic treatment for hydrocephalus. J Neurosurg Pediatrics 10:463-470, 2012
Schiff SJ, Ranjeva S, Sauer T, Warf BC. Rainfall drives hydrocephalus in East Africa. J Neurosurg Pediatrics 10:161-167, 2012 DOI -10.3171/2012.5.PEDS11557
Warf BC, Tracy S, Mugamba J. Long term outcome for combined endoscopic third ventriculostomy and choroid plexus cauterization (ETV-CPC) compared to ETV alone for congenital aqueductal stenosis in African infants. J Neurosurg Pediatrics 10:108-111, 2012
Warf BC. Congenital idiopathic hydrocephalus of infancy: the results of treatment by endoscopic third ventriculostomy with or without choroid plexus cauterization and suggestions for how it works. Child’s Nervous System 29(6):935-940, 2013
Lane J, Mugamba J, Ssenyonga P, Warf BC. Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: A retrospective cohort study in 160 Ugandan children J Neurosurg Pediatr. 2014 Feb;13(2):140-4
Stone S, Warf BC. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series. J Neurosurg Pediatr 14:439-446, 2014
Marano PJ, Stone SSD, Mugamba J, SSenyonga P, Warf EB, Warf BC. Reopening of obstructed third ventriculostomy. Long-term success and factors affecting outcome in 215 infants. J Neurosurg Pediatr 15:399-405, 2015
Kahle K, Kulkarne A, Limbrick D, Warf BC. Hydrocephalus in children. Lancet. 2015 Aug 6. pii: S0140 MJ-6736(15)60694-8. doi: 10.1016/S0140-6736(15)60694-8. [Epub ahead of print]
Boivin MJ, Kakooza AM, Warf BC, Davidson LL, Grigorenko EL. Reducing neurodevelopmental disorders and disability through research and intervention. Nature 527:S155-S160, 2015