Research and Advances
Samuel R. Browd, MD, PhD, leads a nationally renowned team of clinicians and scientists at Seattle Children’s who are driven to improve patient care for hydrocephalus in the short term and cure the condition in the long term.
Treatment of hydrocephalus has been frustrating on many levels. Hydrocephalus is one of the most common congenital conditions in children. It affects 1 in 500 to 1,000 live births. It’s the most common diagnosis that pediatric neurosurgeons see, and it’s a major social, medical and economic problem. Each year hydrocephalus accounts for more than $3 billion in healthcare expenses and about 4% of all pediatric hospital charges in the United States. Yet children with hydrocephalus still face many challenges. Research that leads to more effective care is greatly needed.
The team at Seattle Children’s is working in four areas: clinical research, basic science research, bioengineering and global outreach.
“Research into the cause and treatment of hydrocephalus provides the ultimate pathway for a cure. Our collaboration with other premier children’s hospitals moves us closer to the day when hydrocephalus is relegated to the historical record of pediatric neurosurgery.”
One of the challenges with hydrocephalus is the high rate of infection in children who have a shunt. Nationwide, the infection rate is upwards of 15%. Anytime a child’s shunt gets infected, it means they need:
- Surgery to remove the shunt
- Surgery to place a tube that drains cerebrospinal fluid (CSF) out of their body (external drain)
- Antibiotics for 10 to 14 days in the hospital
- Surgery to put in a new shunt
At Seattle Children’s, we have been working hard to reduce shunt infections. We put in place a standard process that all team members follow when doing shunt surgery and giving antibiotics around the time of surgery. We now have one of the lowest infection rates in the nation – less than 5%.
Shunts have a very high failure rate that has not improved since shunts were developed more than 50 years ago. Nationwide, the first shunt fails for nearly all hydrocephalus patients: 30% fail within the first year, 40% fail within two years, and 98% fail within 10 years. Shunt failure means a child needs surgery to re-place or reprogram the shunt (shunt revision).
Seattle Children’s has been a world leader in the use of stereotactic neuronavigation – “GPS-guided” brain surgery – to place shunts with precision. We use CT (computed tomography) scans or MRI (magnetic resonance imaging) to make a three-dimensional model of a child’s anatomy. This way we can pick the precise entry site and target site for the shunt tubing and insert it into the right place in the ventricle in only one try. This has greatly reduced our rate of shunt revisions.
Children with hydrocephalus need many imaging scans of their heads during childhood. Seattle Children’s uses rapid-sequence MRI to avoid radiation exposure for these children. We have also been leading efforts to reduce the amount of radiation children get from CT scans. Our patients get only one-quarter to one-half the usual dose. These steps reduce a child’s lifetime radiation exposure, while still giving us the images we need.
Hydrocephalus Clinical Research Network
Seattle Children’s belongs to the Hydrocephalus Clinical Research Network (HCRN). This is a group of leading children’s hospitals that focuses on improving hydrocephalus care. Through our work in the HCRN, we maintain a patient database. This helps us better understand hydrocephalus and develop new treatments for it. We are also involved in many clinical trials through the HCRN.
The goals of our research are to:
- Reduce infections associated with shunt surgery
- Improve treatment of shunt infections
- Understand endoscopic third ventriculostomy (ETV), a surgery to treat some forms of hydrocephalus without a shunt
- Create a detailed registry of patients at HCRN hospitals
- Improve shunt placement using ultrasound guidance
- Manage hydrocephalus in children born early (prematurely)
Basic Science Research
Basic science research aims to expand our knowledge by exploring interesting scientific questions. It’s the groundwork that must be done in order to discover new treatments. Our basic science research into hydrocephalus is led by William B. Dobyns, MD, at Seattle Children’s Research Institute, along with Dr. Browd and his clinical colleagues. Our long-term goal is to cure this condition.
Our approach is to try to understand the genetic basis for hydrocephalus and then use this knowledge to devise treatment methods. We are also using high-end research techniques such as proteonomics, the study of proteins made in cells. Proteins in CSF may give us clues about why hydrocephalus happens. This could lead to treatment that doesn’t require surgery. Through the support of the Hydrocephalus Research Guild, we are creating a database so we can perform genetic research and maintain a tissue bank that holds CSF for research purposes.
“It is an honor to lead the clinical research effort and partner with our basic science faculty as we build a world-class translational research program devoted to hydrocephalus.”
Another important area of research for us is in bioengineering (using principles of engineering in medicine to invent or refine devices to improve patient care). Dr. Browd has worked with Barry R. Lutz, PhD, of the University of Washington Department of Bioengineering to develop a revolutionary new shunt valve. Its design improves many issues that have played a role in shunt failure. With the new shunt, which should be available by 2015, we hope to reduce the shunt failure rate by 50%.
As an international leader in hydrocephalus care, the Seattle Children’s Neurosurgery team has trained neurosurgeons from around the world. These neurosurgeons return to their home countries to improve hydrocephalus care. We are proud to help others provide better treatment across the globe by sharing what we’ve learned from our research.