Hydrocephalus Research
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 life-long condition, and shunting is not a perfect treatment.
Up to 15 percent 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 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 percent to less than 10 percent in 2005.
In addition, more than 50 percent 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 percent 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 & 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.
Questions and answers with Dr. Anthony M. Avellino
Dr. Anthony M. Avellino
Q: What is the focus of your research?
A: Our team is:
- Studying and defining the proteins in the CSF of children with and without hydrocephalus
- Defining the combinations of proteins (profiles) in children with and without hydrocephalus that may affect their cognitive development
- Identifying and understanding the nature of thousands of proteins in complex CSF protein mixtures from children with and without hydrocephalus
- Doing this with a speed, sensitivity and accuracy not possible before with other methods
- Using this information to regulate proteins and genes in order to avoid using shunts
Q: How will these findings benefit children with hydrocephalus?
A: They will help us:
- Better understand the development of hydrocephalus in relation to injury, survival and brain development
- Develop new molecular and medicine therapies to balance the proteins in a child’s CSF that regulate CSF production and/or absorption
- Increase the body’s ability to absorb CSF
- Find ways to treat children without using ventricular shunts
- Improve a child’s chance of normal neurological and cognitive development