Seattle Children’s clinicians and scientists lead research to improve care for patients with hydrocephalus and find a cure.
Hydrocephalus is one of the most common congenital conditions in children. It may affect a child’s brain development, ability to learn and understand, memory, social skills or other functions.
Despite efforts to improve treatment, children with hydrocephalus still face many challenges, such as the risk of shunt infections and the need for multiple surgeries in some cases. Research that leads to more effective care is greatly needed.
Our nationally renowned team, including Dr. Samuel R. Browd, director of hydrocephalus, works in 4 areas to improve hydrocephalus care: 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. 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 (CSF) out of the body (external drain)
- Antibiotics for 10 to 14 days in the hospital
- Surgery to put in a new shunt
Nationwide, the infection rate is about 15%. At Seattle Children’s, we have one of the lowest infection rates in the nation: Our annual infection rate averaged 3.1% from 2010 through 2014. To reduce the risk of 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 are also doing research to tell whether the timing of surgery to put in a new shunt after an infection changes the risk for future infections.
Shunts fail at a very high rate — often because they become blocked over time by the child’s own blood cells or tissue. The failure rate has not improved since shunts were developed more than 50 years ago. Nationwide, the first shunt fails for nearly all hydrocephalus patients at the following rates: 30% fail within the first year, 40% fail within 2 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 uses stereotactic neuronavigation — “GPS-guided” brain surgery — to place shunts with precision. Before surgery, we use CT (computed tomography) scans or MRI (magnetic resonance imaging) to make a 3-dimensional model of a child’s anatomy. The model allows us to pick the precise entry site and target site for the shunt tube (catheter). During surgery, we use the model to insert the catheter into the right place in the ventricle in only 1 try. This has greatly reduced our rate of shunt revisions.
To learn more about why shunts fail, Dr. William Shain, from Seattle Children’s Center for Integrative Brain Research, studies shunts we have removed. Instead of throwing away these failed devices, we are looking for clues that might help us design a better model. Using a microscope, Shain examines the catheter that goes into the brain to see how a patient’s cells bind to it, blocking the flow of CSF. His research may lead to changes in the structure of catheters, a coating that keeps cells from binding to catheters or other improvements.
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 ¼ to ½ of the usual dose. Our research shows that low-dose CT scans reduce a child’s 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 work together on clinical trials to improve hydrocephalus care for all children. Through our work in the HCRN, we keep a database of patients with hydrocephalus that helps us better understand the condition and develop new treatments.
The goals of HCRN research are to:
- Reduce infections associated with shunt surgery
- Improve treatment of shunt infections
- Study endoscopic third ventriculostomy (ETV), a surgery to treat some forms of hydrocephalus without using a shunt, and better understand which patients can benefit from it
- Create a detailed registry of patients at HCRN hospitals, which helps us track trends over time and generate future studies
- Improve shunt placement by using ultrasound guidance to reduce the need for shunt revisions
- Manage hydrocephalus in children who are born early (prematurely)
Basic Science Research
Scientists doing basic research into hydrocephalus work to expand our knowledge about hydrocephalus, including what it is and why and how it happens. This type of research is essential in order to discover new treatments. Dr. William B. Dobyns, at Seattle Children’s Research Institute, leads our basic science research into hydrocephalus, along with Browd and others on our hydrocephalus treatment team. Our long-term goal is to cure hydrocephalus.
We want to understand the genetic basis for hydrocephalus and then use this knowledge to devise treatment methods. We are also studying proteins in CSF, which may give us clues about why hydrocephalus happens. This could lead to treatment that does not 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."
Bioengineering uses engineering principles to invent or refine devices to improve patient care. Browd has worked with Dr. Barry R. Lutz of the University of Washington Department of Bioengineering to design and develop a revolutionary new shunt valve. With the new shunt, which should be available in the next several years, 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 have learned from our research into shunt infections, shunt placement and other aspects of hydrocephalus treatment. We also teach visiting neurosurgeons about research methods so they can set up hydrocephalus research projects at their local healthcare centers.