Research and Advances
Samuel R. Browd, MD, PhD leads a nationally renowned team of clinicians and scientists at Seattle Children’s Hospital 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 is the most common diagnosis that pediatric neurosurgeons see and it is 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.
Our team works 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%. Any time a child's shunt becomes infected, the child will need:
- Surgery to remove the shunt
- Surgery to place a tube to drain cerebrospinal fluid out of the 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 one of the lowest infection rates in the nation: less than 5%.We put in place a standard process that all team members follow when doing shunt surgery and giving antibiotics around the time of surgery.
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 with the following rates: 30% fail within the first year, 40% fail within two years and 98% fail within 10 years. Shunt failure means that the child will need surgery to replace 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 computed tomography (CT) scans or magnetic resonance imaging (MRI) to make a three-dimensional model of a child's anatomy. With the use of these technologies, 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 who have 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 of the usual dose. These steps reduce a child's lifetime radiation exposure, while still providing 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 that helps us to better understand hydrocephalus and develop new treatments. 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 using a shunt.
- Create a detailed registry of patients at HCRN hospitals.
- Improve shunt placement by using ultrasound guidance.
- Manage hydrocephalus in children who are born early (prematurely).
Basic Science Research
Basic science research aims to expand our knowledge by exploring interesting scientific questions. This type of research is 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 cerebrospinal fluid (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.