Archive for the ‘Research’ Category

Managing Children by a Simple Touch of the Hand

By Jay Wellons, Saturday, January 11th, 2014

While this article was published in January 2013, HCRN recently acquired public access to the article so we are reposting this topic.

For many years, pediatric neurosurgeons have made decisions on the treatment of infants with hydrocephalus by the touch of a hand to the head. A gentle maneuver that implies care and reinforces the importance of touch in the physician-patient relationship, but in that simple touch of the soft spot of the head, the “anterior fontanel” in more formal terms, much is conveyed. Is the brain soft and at ease? Or is it under pressure from a subtle yet-to-be-fully-defined disease process, starting to struggle against the confines of the skull and bulge up, not only giving the soft spot a rounded appearance, but also beginning to widen the skull sutures where the thin plates of the skull come together?

This was the question that the investigators of the Hydrocephalus Clinical Research Network asked. Can a simple test, thought to be time-honored and true, be consistent across physicians? More and more studies show that variation drives practice and perhaps even outcomes. Using the strength of the collaborative nature of the HCRN, each center tested this reproducibility among surgeons. Could they each independently come to the same conclusion and therefore take the next step necessary for treatment? The answer from this study was a resounding yes. The ability to assess the soft spot and underlying presence of subtle pressure among surgeons in the network was high. This answer, this straight forward determination of the simple touch of a hand, underpins the very nature of the research that is done in the HCRN.

You can read the study as published in the Journal of Neurosurgery: Pediatrics in January 2013 here.

First Report from HCRN’s Large Registry

By John Kestle, Monday, July 8th, 2013

The HCRN registry is a huge database collecting detailed information on children at the HCRN centers. The information is entered in real time as children are treated and continuously checked for accuracy. This makes it a very valuable resource. Dr Jay Riva-Cambrin is the lead investigator for this project and at the American Society of Pediatric Neurosurgeons in February he presented the first analysis of the data. Dr Riva-Cambrin and our Ph.D. biostatistician, Richard Holubkov, looked at the factors that predict shunt failure in 1036 children after the first shunt insertion. They found that children under 6 months of age and children who had their shunt inserted with an endoscope had a higher chance of shunt failure. In addition, children with a congenital heart problem were at increased risk. Even more interesting was the list of factors that did not alter the risk of failure. This included: the cause of hydrocephalus, the type of valve used (including programmable valves), the use of ultrasound or guidance during the surgery, and surgeon volume. These important findings are now being prepared for publication and they will help us advise families and guide our future research.