Advanced Imaging in Pediatric Hydrocephalus
Gruss MRRC at Einstein College of Medicine
1300 Morris Park Ave,
Bronx, NY 10461
Why is this research being done?
Shunting is the primary treatment for hydrocephalus, and many children and young adults who have been shunted early in life for hydrocephalus due to in utero complications, will live with their shunt for the rest of their life. Unfortunately, more than half of these patients will suffer from debilitating neurological deficits, leading to developmental delays, and problems in school, for example. Just as troubling, most shunts will fail within two years, and many kids will have to undergo multiple surgeries with the associated risks and the further delays in their schooling. A shunt is ideally designed to bring the ventricles down to their normal size but shunt-induced overdrainage can lead to smaller than normal or slit ventricles. This occurs in close to half of the patients. This can lead to blockage of the shunt, but we think it may also lead to atypical brain development, and may be one of the reasons for cognitive and motor deficits and developmental delays.
Shunt-related headache, often incapacitating, is a common occurrence in hydrocephalus. Better methods for guiding shunt surgery or for developing alternate therapeutic strategies which can limit the risks associated with shunting must be developed. Unfortunately, non-invasive methods for reliably predicting shunt outcome simply do not exist. Without ways to predict long-term outcome, development of such alternative treatments will not make progress, because researchers cannot provide evidence-based proof of their efficacy. Methods for prediction do currently exist, but they are all based on invasive procedures, such as ICP monitoring. Thus, there is an urgent need for development of noninvasive methods for guiding hydrocephalus therapy, predicting cognitive outcome and helping understand health issues such as headache in these patients. Brain imaging is an ideal method for doing this, and fortunately recent technological advances in advanced brain imaging techniques have provided these types of tools.
What are they doing?
Doctors have been using palpation for decades in order to assess the health of tissue, but this has always been limited to areas of the body which the doctor can feel. Because of the skull, this is obviously not possible in the brain. Our research involves a cutting-edge type of MRI which allows us to do just that. We can see what the brain “feels like” without touching it; it lets us see changes in the stiffness of brain tissue completely noninvasively. We believe that this novel type of MRI, called MR Elastography (https://en.wikipedia.org/wiki/Magnetic resonance _elastography), will let us see if there are differences in the brain of children with hydrocephalus, differences which might make them more susceptible to problems such as slit ventricles, headache or developmental delays. This might be due to changes in brain development from atypical size or shape of the ventricles, overdrainage, or multiple shunt surgeries.
Using these advanced techniques, we are studying the effects of hydrocephalus on the stiffness of the brain and its association with important clinical measures such as shunting history and headache severity.
Who is eligible to participate in this study?
Patients who are eligible to participate in this study must be between 6 and 25 years old. Detailed screening for the trial will occur through an online survey.
How do I know if I am eligible for this study?
If the patient is between 6-25 years old, they will be asked to complete a short (10 minute) online questionnaire that deals with the patient’s hydrocephalus history, treatment history, and any current problems with headaches the patient may have. Even if the patient does not suffer from headaches, he/she can still complete the questionnaire.
All information in the questionnaire will remain strictly confidential. If the person filling out the questionnaire is under eighteen years of age or has any cognitive impairment, someone over the age of eighteen should assist them as necessary.
From the results of the survey, the research staff will determine whether or not the patient is eligible for the next phase of the study.
This will involve the patient filling out a 20-minute survey and undergoing a new type of MRI at the Albert Einstein College of Medicine. There is no cost to the patient for this MRI. If the patient agrees to participate, he/she will be compensated $100 for his/her time and transportation costs.
The survey will collect some demographic information, clinical information such as headache severity and shunt revision history as well as some cognitive and depression measures.
Patients who cannot travel to the Bronx or are not interested in coming in for the MRI part of the study, can also fill out the 20-minute survey online. They will be compensated $10 for filling out the survey. All information in the survey will remain strictly confidential.
Questions about the study can be addressed to: