Out this month, the first edition newsletter of the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF), an international society promoting basic and clinical research in CSF circulation and related disorders, featured two studies published last year by the Hydrocephalus Clinical Research Network (HCRN). Inclusion in this newsletter highlights the continued impact of the HCRN on hydrocephalus research.
The first study, A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection, was published in the Journal of Neurosurgery: Pediatrics in December, 2015. The study compared infection rates when neurosurgeons followed a standardized protocol during neurosurgery for shunt insertion compared to when the neurosurgeons did not comply, or follow, the full protocol. The study showed that complying with the protocol reduced the risk of shunt infection by 43% (8.7% infection rate compared to 5.0% infection rate). In this study, the protocol included the use of antibiotic-impregnated catheters (AICs). Therefore, the HCRN also compared the shunt infection rates between the current protocol (using AICs) and a previously published HCRN shunt infection protocol that did not require use of AICs. Comparing the two protocols, there was no significant difference between the reported shunt infections rates. Therefore, it is not clear if the use of AICs in addition to following a standard protocol provides additional protection against shunt infections.
The second study, Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study, was also published in the Journal of Neurosurgery: Pediatrics in December, 2015. The study aimed to identify risk factors for shunt failure (malfunction or infection) in the pediatric hydrocephalus population. Over 1,000 children were enrolled in the study, and, on average, the children were followed for 400 days. The results showed that 33% of the children experienced shunt failure, and that majority (77%) of shunt failures were due to shunt malfunction.
Three factors were independently associated with a higher risk of shunt failure:
- Age less than six months (age at shunt insertion)
- Presence of a cardiac comorbidity (heart and great vessel malformations, cardiomyopathies, and conduction disorders and dysrhythmias)
- Use of an endoscope (medical device consisting of a long, thin tube with a list and video camera attached)
Surprisingly, the etiology, or cause, of pediatric hydrocephalus was not a significant risk factor. The authors hypothesize that etiologies previously shown to be linked to an increased risk of shunt failure, such as posthemorrhagic hydrocephalus, are over represented in the category – age less than six month. This may explain the disagreement between studies.
The Hydrocephalus Association is proud to support the HCRN and the work of both basic and clinical researchers funded through the Hydrocephalus Association Research Programs.