Dr. Anthony M. Avellino’s current research focuses on better understanding hydrocephalus and improving neurological and cognitive development in children with this condition.
About Hydrocephalus
Hydrocephalus is one of the most common congenital (present at birth) problems in children and the most common clinical problem pediatric neurosurgeons face. It happens to one child per 1,000 live births and is a major social, medical and economic problem.
In the year 2000, about $1 billion of U.S. health care expenses were related to hydrocephalus shunt procedures.
Cerebrospinal fluid is important to the human body, making hydrocephalus research a priority. CSF bathes and cushions the brain and quickly transfers signals between its different areas.
If CSF proteins change during different stages of hydrocephalus, it may harm brain development and a child’s chances of survival.
A child with hydrocephalus has too much CSF inside the ventricles of the brain. The treatment for hydrocephalus — the shunt — has saved many lives. However, we still don’t have a cure.
Hydrocephalus is almost always a lifelong condition, and shunting is not a perfect treatment.
Up to 15% of children with shunts have painful problems during their lifetime — problems like infections or shunts that don’t work properly. This often means operating many times on a child to replace the shunt. Dr. Avellino and his colleagues would like to save children from this pain.
At Seattle Children’s, we’re asking, “How can we treat patients in a less invasive manner and possibly cure hydrocephalus?”
About Shunts
When a child has hydrocephalus, a neurosurgeon places a shunt, a small tube called a catheter and a valve, inside one of the brain’s four ventricles.
The shunt drains the extra, normal CSF from the brain to another part of the body, usually the abdomen (near the stomach), where the body reabsorbs it. Learn more about shunts.
A reliable ventricular shunt was developed in the 1960s. Since then, the death rate from hydrocephalus has dropped from more than 50% to less than 10% in 2005.
In addition, more than 50% of children with shunted hydrocephalus develop normal awareness and judgment. Today, more and more children with shunted hydrocephalus live into their adult years.
These longer lives challenge us to find new and innovative treatments that can ensure that more children have normal cognitive development.
Shunt Alternative Research
Most hydrocephalus-related research has studied problems related to brain injury caused by hydrocephalus.
These problems include:
- Increased brain pressure (intracranial pressure)
- Stroke (cerebral ischemia)
- Low levels of oxygen (hypoxia)
- Physical disruption of axons and neurons
- Changes in the extracellular microenvironment
A child’s extracellular microenvironment is everything outside the nerve cells, such as chemicals and nutrients.
Using two-dimensional electrophoresis, past studies identified fewer than 100 proteins in CSF. Using new high-resolution mass spectrometry (HRMS) techniques gives us the ability to identify thousands of CSF proteins.
As far as we know, scientists have not used HRMS to study the proteins and genes in the ventricular CSF of children with hydrocephalus.
We hope that our findings will lead to treatment for hydrocephalus that changes these proteins and genes instead of installing shunts.
Cognitive Development After Shunting
Currently 50% of children with shunts do not develop normal cognition. Often, the brain can reconstitute after shunting — the extra CSF drains, the ventricles shrink and the supporting cells thicken — and “return to normal.”
One of the critical questions facing pediatric neurosurgeons caring for children with hydrocephalus is "why is the developmental outcome for children with shunted hydrocephalus different even after their brain cells reconstitute?"
CT scans of two children (B and C) with shunted hydrocephalus, small ventricular size and increased brain matter. Compared to their initial CT like that shown in “A” with hydrocephalus, “B” has normal cognitive development and “C” has impaired cognitive development.
The Hydrocephalus Research Pinwheel
Goals of the Hydrocephalus Clinical Research Network (HCRN)
- Create a detailed registry of patients at participating institutions
- Improve shunt placement using ultrasound guidance
- Reduce infections associated with shunt surgery
- Improve treatment for shunt infections
- Manage hydrocephalus in premature children
- Understand endoscopic third ventriculostomy (ETV), a surgical technique for treating some forms of hydrocephalus without using a shunt
Dr. Samuel R. Browd: "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. It is an honor to lead the clinical research effort and partner with our basic science faculty as we build a world-class translation research program devoted to hydrocephalus."
Involves Drs. Samuel Browd, Jeffrey Ojemann and Richard Ellenbogen.
Global outreach
Through neurosurgical outreach to underdeveloped countries, we are providing training and education to physicians and healthcare providers who care for children with hydrocephalus.
Involves Drs. Samuel Browd, Jeffrey Ojemann and Nathan Nair.
Seattle Children's Research Institute
SCRI is implementing bench research to better understand potential causes and cures and the effectiveness of pharmaceutical treatments.
Involves Drs. Nino Ramirez, Samuel Browd and Anthony Avellino.
Bioengineering
Research and re-engineering of shunt design.
Involves Drs. Samuel Browd and Barry Lutz.