John Kestle, MD, professor of neurosurgery at University of Utah Health, is the principal investigator on a major $10M National Institutes of Health-funded grant that is studying care improvements for infants with hydrocephalus. His team will be leading 14 North American pediatric neurosurgical centers in a randomized clinical trial testing endoscopic versus shunt treatment.
Hydrocephalus is a potentially debilitating neurological condition that affects babies under a year or two of age and has traditionally been treated by inserting a cerebrospinal fluid shunt (CSF) between the brain and the abdomen. A newer endoscopic procedure offers hope of shunt-free treatment that may reduce cost and complications over a child's life, but it is uncertain whether these two methods result in similar outcomes. The study aims to compare intellectual outcome and brain structural integrity between these two treatments, to help families make the best treatment decision for their baby.
Shunt-based treatments are expensive and have complications that adversely impact quality of life. Surveys of families affected by hydrocephalus show that they desperately desire shunt-free treatment, but only if it doesn't harm cognitive function
The Hydrocephalus Clinical Research Network (HCRN), which Kestle chairs, has shown that endoscopic third ventriculostomy with choroid plexus cauterization is the most effective shunt-free treatment for infants. However, the cognitive impacts, which are the primary concern for family members, remain unknown.
Kestle's research seeks to determine whether this treatment results in non-inferior cognitive outcomes measured by the Bayley Scales of Infant and Toddler Development (Bayley-IV) Cognitive Scale, as well as with additional assessments as they grow. Children will be enrolled into the study as infants undergoing their first permanent hydrocephalus procedure and will be followed over time as they enter their preschool and kindergarten years. This study is planned to take seven years to complete.
"Shunts have been the treatment of hydrocephalus for over 50 years. The possibility of an effective alternative is very exciting for patients, families and those of us who treat this condition. I am very happy that the University of Utah and the HCRN are leading this international effort."