The disruption in the hydrodynamics of cerebrospinal spinal fluid (CSF) flow, production, and absorption leads to hydrocephalus. This condition can be life-threatening if left untreated and has a bimodal distribution in its peak incidences.
There is a peak in infancy, usually associated with congenital malformations and a second peak after the age of 60 years. Symptoms of hydrocephalus are legion. They vary with age, ranging from vomiting, irritability, and reduced activity in infants to visual disturbances, decreased mental capacity, and unstable balance in older children and older adults.
Diagnosis can be done with the use of imaging techniques such as ultrasound in infants and MRI or CT scans in everyone else. Treatment is usually surgical and involves, where applicable, the removal of masses that cause blockage, the creation of a shunt to re-route CSF flow, or cauterization of the choroid plexus together with third ventriculostomy to reduce CSF production. While the condition itself and its associated therapy may cause complications, such as neurological deficits, shunt failure, and infection, early detection with prompt and diligent treatment is predictive of favorable long-term outcomes.
Many of the challenges associated with hydrocephalus are due to the procedures performed in order to treat it; thus, several studies are being done to limit these unwanted complications. Infection is one major problem that may occur after surgery and requires removal of the shunt, surgical drainage of CSF, a course of antibiotics, and the insertion of a new shunt. As a result, there is research being done to determine if placing a new shunt following an infection alters the risk of developing future infections.
In addition to infection, shunt failure is also another problem that needs to be overcome. It is estimated that within a decade up to 98% of shunts may fail. Taking this into consideration, several groups around the world are investigating why this happens and are looking for ways to improve existing models.
One such group may be found at the Center for Integrative Brain Research at the Seattle Children’s hospital. At this center, Dr. William Shain and his team study shunts that have been removed after failure and are searching for clues that may lead to several improvements, such as changes in catheter structure as well as a possible coating to prevent cells binding to catheters.
Clinical Research Network
The Hydrocephalus Clinical Research Network consists of many children’s hospitals working together to effect improvements in current treatment. This group of institutions has several aims with regards to their research. They study ways to effectively manage premature babies born with hydrocephalus and decrease infection risks associated with surgery. Furthermore, they investigate alternative forms of surgery that do not involve the placement of shunts, like endoscopic third ventriculostomy.
The clinical research network ensures that data collected is properly registered for tracking and future use. Moreover, research is also being done to create ways that are non-invasive to measure intracranial pressure as well as to look into the development of drug therapies for hydrocephalus.
Reviewed by Susha Cheriyedath, MSc