School of Medicine

Most people know some family with a Hydrocephalic child. Some people have even seen children with very large heads; some are retarded or developmentally delayed, but others appear relatively normal. As medical technology improves, more children with Hydrocephalus grow up looking normal. Ironically, their struggles to combat frequent recurrences, their frustrating search to find educational programs that can help their earning disabilities, their fear of not being insured when they reach 18 because of their pre-existing condition, and the incredible strain on their families, all may go unnoticed. But there are many poignant testimonials that drive home the devastating impact of Hydrocephalus on children and their families.

Hydrocephalus is one of the most common congenital defects of the central nervous system. These defects occur 1-8 times in every 1000 live births, and are often associated with Spina Bifida, another congenital defect that involves the vertebral column and spinal cord. About 1500 children with Spina Bifida are born each year. The annual cost of treating childhood Spina Bifida and Hydrocephalus in the United States as been estimated to be over $200 million, but these estimates do not take into consideration the financial and emotional toll that burdens each family.

Not only is the prevalence of Hydrocephalus high, but the very high frequency of shunt malfunction due to blockage or infection makes Hydrocephalus a particularly insidious problem. Often children must endure 15-50 or more surgeries to repair a non- functioning shunt, and pediatric neurosurgeons devote a majority of their practice to the treatment of Hydrocephalus. The Children's Hospital of Michigan is the busiest Hydrocephalus center in the country, with nearly 1800 Hydrocephalus-related surgeries performed annually.

Although this tragic disorder can be diagnosed in early gestation or infancy, it is disheartening that today many affected children cannot be treated properly because so little is known about the brain damage caused by hydrocephalus. Neurosurgeons and engineers alike constantly strive to develop better drainage systems for hydrocephalic patients. Nevertheless, their expertise is severely limited by the lack of data on brain damage created by hydrocephalus. For example, we still do not have all the answers to important questions like:

1. What causes Hydrocephalus?
2. Why do some children with hydrocephalus experience very few problems, while others need endless shunt revisions?
3. Can injured neurons be rescued or protected?
4. Are the connections between neurons severed or altered as the brain is distorted during hydrocephalus?
5. Can these connections be protected during hydrocephalus or encouraged to regrow after a shunt is placed?
6. How does hydrocephalus affect brain chemistry, especially for the critical neurotransmitters that allow neurons to communicate properly?
7. Do permanent "scars" form in the brain during hydrocephalus?
8. Do these scars change the mechanical properties of the brain, making it more "stiff", for example, and thus creating the need for a different type of shunt?
9. Can neuron damage and scars be prevented by supplemental treatments that could be given along with the shunt?
10. How can infections be better controlled?
11. How can tissue growth into and around shunts be prevented?
12. Can diagnosis and monitoring be improved?
13. Will very early, perhaps intra-uterine, treatment be more effective?