Best of 2012
The Gift of a Life Without a Shunt
Seattle Children’s is among the first to offer a surgical treatment that gives children with hydrocephalus the hope of a life free from the burden of a shunt.
Hydrocephalus is one of the most common congenital conditions in children, affecting 1 in 500 to 1,000 live births.
Neurosurgeon Dr. Samuel Browd is dedicated to giving children with hydrocephalus a better quality of life by offering the latest neurosurgical technique instead of the traditional treatment of shunting.
Shunt technology has not changed since the 1950s. They have a high infection rate and often fail without warning – 30% fail in the first year and almost 100% fail within 10 years. Shunt failure is a life-threatening emergency requiring surgical replacement. About 38,000 shunt replacement surgeries are performed in the U.S. each year.
Living with these risks is very difficult for families.
“Shunts have worked well in terms of getting the job done and moving fluid from one place to another but they come with a lot of baggage,” says Browd. “Many families don’t go on vacations anymore because they don’t know when the shunt may fail and they’re worried there’s not going to be a neurosurgeon close by if it does. It’s a very difficult way to live life.”
Eliminating the need for a shunt
Thanks to Browd, in 2012 Children’s became the only hospital in the region to offer an innovative surgical procedure that combines two treatments for hydrocephalus that don't involve a shunt.
During a surgery called Endoscopic Third Ventriculostomy (ETV), neurosurgeons create a pathway to allow cerebrospinal fluid (CSF) to reach the areas around the brain where it is absorbed. Then they perform Choroid Plexus Cauterization (CPC), applying heat to the tissue in the brain that makes the CSF and reducing the amount that is produced.
“The beauty of ETV/CPC is that if it’s successful, then you’ve essentially treated the hydrocephalus and the child can become shunt independent,” says Browd. “The pressure is reduced, the brain can re-expand and children can hopefully go about a normal life.”
Browd and his team were inspired to introduce the new procedure after meeting its pioneer, Dr. Benjamin Warf, at the 2012 Hydrocephalus Research Conference held in Seattle. Browd organized and directed the conference, which received support from the National Institute of Neurological Disorders and Stroke (NINDS), the leading federal funder of brain science at the National Institutes of Health.
Warf, currently the director of Neonatal and Congenital Anomaly Neurosurgery at Children’s Hospital Boston, moved with his family to Uganda in 2000 to help establish a hospital for pediatric neurosurgery. Because accessing medical care is so challenging there, Warf developed the novel ETV/CPC technique to give Ugandan children a treatment option that required less intervention and dependency on a medical device – especially a device that has such a high failure rate.
Warf has performed neurosurgeries on thousands of children in Uganda and the treatment has been highly successful. More than half of infants who received the surgery are cured without requiring continued treatment.
“Bringing this innovative procedure to the Pacific Northwest opens up the possibility that a large portion of patients may be able to live without shunts, and that is an exciting new phase in the treatment of hydrocephalus,” says Browd. “We are thrilled about the technology and we think it will be great for patients and families.”
Implications for the future
While ETV/CPC is currently a possible treatment for some babies with hydrocephalus that are less than 1 year of age, Browd thinks that over time they may be able to offer it to older children and adolescents.
Children’s is one of seven leading pediatric centers in the U.S. and Canada that will participate in a multicenter trial to evaluate the technique. The trial will begin in the second quarter of 2013 and will likely last for one to two years.
“It’s a promising procedure and it is something that we will be tracking very closely,” says Browd. “The results of the trial will inform our decision to broaden the patient population that can undergo this exciting new procedure.”
“It opens up the possibility that a large portion of patients may be able to live without shunts, and that is an exciting new phase in the treatment of hydrocephalus.”
– Dr. Samuel Browd