pathways winter 2010 - hydrocephalus association · 2016. 9. 13. · singh, kuldev. journal of...

Abhishek Deshpande, MD, at theClevelandClinic for: “Effects of VEGFagonist (rVEGF) and VEGF antago-nist (Bevacizumab) treatment on cere-brovascular density and permeabili-ty and learning in a kaolin model ofhydrocephalus.”

Ramin Eskandari, MD, at theUniversity of Utah for: “Early versuslate CSF drainage treatment in exper-imental neonatal hydrocephalus.”

Dana W. Moore, PhD, at the WeillCornell Medical College of CornellUniversity for: “Quantitative meas-urement of ventricular volume andcortical atrophy to improve diagno-sis of normal pressure hydrocephalus.”

Joon W. Shim, PhD, at Children’sHospital Boston for: “The role of an-giogenesis in hydrocephalus.”

Yun C. Yung, doctoral student atthe Scripps Research Institute for:“Lysophosphatidic acid (LPA) signal-ing in hydrocephalus.”

Pathways

www.hydroassoc.org

Donna Shaffer, Research Associate and Tom Smith, Outreach&Media Liaison

RESEARCH INITIATIVE TAKES OFF

Winter 2010 ~ Vol. 28, No. 1

We are proud to announce research grants to scientistsat five medical research facilities across the nation.This is the culmination of a longstanding dream of

the Hydrocephalus Association (HA) and our community, totake an active part in creating innovative research in hydro-cephalus, with the goal of one day finding a cure.These “Mentored Young Investigator” awards demonstrate

our first step in finding a cure. Our longer-term goal is to in-crease the volume of research tenfold by the year 2013, and tofurther stimulate federal funding.

The process started in July 2009 when the HA announced aRequest for Applications (RFA) for a Mentored YoungInvestigator (MYI) research award. Each application was eval-uated by the HA Scientific and Medical Review Committee(SMRC), based upon the following criteria: mentor and train-ing environment; likelihood that the proposed project will ad-vance hydrocephalus treatment/cure; scientificmerit of the re-search proposal; and applicant training and career potential.As a result of this competitive application process, the HA

Board of Directors is awarding $110,000 per research projectfor years 2010-2011 to the following investigators:

Tom Smith, Outreach&Media Liaison

Welcome to theWinter 2010 editionof Pathways. We hope that 2010 is

being kind to you. Now, to business!Our Research Initiative has been

launched at last! I am utterly thrilled.Credit goes to the vision, drive and ef-forts of our members, Board of Directors,Medical Advisory Board and generousdonors. Five talented young scientists arebeing directly funded by the HA to pur-sue hydrocephalus research that will ben-efit our entire community. We’ve talkeda good deal about launching this initia-

tive over the last several newsletters; hav-ing talked that talk, now we get to walkthat walk.Registration is now open for the 11th

Annual National Conference onHydrocephalus, scheduled for June 17-20. We look forward to seeing you inCleveland, the Rock ‘n’ Roll Capital ofthe United States. It is the best way to ed-ucate ourselves about hydrocephalus andan unparalleled opportunity to connectwith our wonderful community. Be thereor be a geometric shape with four sidesof equal length. �

WELCOME TO A NEWYEAR! Letter from the EditorRick Smith, Acting CEO

Since last fall,the Hydro-

cephalus Assoc -iation has beenengaged in asearch for a newCEO. On Febru -ary 1, the Board ofDirectors success-fully concludedthat search with the appointment ofLaurene McKillop, PhD. Laurene emergedfrom an incredibly strong pool of candi-dates. TheBoardwas extremely impressedwith Laurene's background and experi-ence, along with her demonstrated com-mitment and energy to improving healthcare.We all look forward toworkingwithher in the years ahead.Laurene comes to the Hydrocephalus

Association with more than 25 years ofexperience in the management of non-profit organizations, primarily in the ar-eas of health, children and family servic-es. She is a dynamic leader who combinessage leadershipwith a demonstrated abil-ity to generate growth.Laurene’s skills include strategic plan-

ning and fundraising, corporate and fis-cal oversight, research direction, andmar-keting and communications. She hasmanaged large centralized staffs as wellas national coalitions of community ad-vocates; directed complex national pro-grams, and worked across the threebranches of government.Laurenewill oversee theHydrocephalus

Association’s strategic relocation to theWashington,D.C.metropolitan area. Thismove will increase the visibility and theimpact of the Association as we work tofind a cure for hydrocephalus, and im-prove the lives of those who are livingwith it. We welcome Laurene, who looksforward to advancing our cause. �

INTRODUCING OUR NEW CEO

2 n Pathways WINTER 2010

IN MEMORY

Dr. Anthony Marmarou, one of our esteemedmembers of the HAMedical Advisory Board,

passed away on January 22. Dr. Marmarou heldtheDr.Harold I. NemuthDistinguished Professor-ship in neurosurgery and served as vice chair of re-search in the department of neurosurgery at theVirginia Commonwealth University, Richmond,Va. Known internationally for excellence in researchon patients with traumatic brain injury and spinalfluid physiology, he was respected as a master atbringing bench research quickly and safely to thebedside to improve patient care. Dr. Marmarouplayed a leading role in establishing clinical guidelines and standards of carefor the treatment of patients with idiopathic normal pressure hydrocephalus.During his more than 27 years at VCU, Dr. Marmarou received significant

and sustainedNIH and industry funding. This included the prestigious JavitsNeuroscience Investigator Award from theNational Institute of NeurologicalDisorders and Stroke. He trained more than 200 research scientists, who arefurthering his legacy in leading laboratories around the world.We will remember his many contributions to neuroscience and to the HA,

as well as his wisdom and dedication to scientific advancement.

��

If you would like more information about how toinclude the Hydrocephalus Association in your will or

estate plan, please contact Rick Smith at: [email protected] 415-732-7040

The HA will maintain two offices, Education & Support in San Francisco and Research & Advocacy in Washington DC.

Pathways n 3WINTER 2010

Join us in Cleveland For Our 11th National Conference

The goal of theHydrocephalus Association’s biennial nation-al conference is to provide tools to address the medical, ed-

ucational and social challenges of living with hydrocephalus –and to enjoy each other’s company!Highlights of the conference scheduled for June 17-20, in

Cleveland, include a keynote address by world-renowned doc-tor, author andmotivational speaker Dr. Michael Roizen; firsttime ever live feed screening of shunt placement surgery andendoscopic third ventriculostomy, performed by our confer-enceMedicalChair,Dr.MarkLuciano; the secondRobert Pudenzlecture sponsored by the Rudi Schulte Research Institute; ahands-on brain anatomy and physiology lab; our ever-popularinterconnection sessions where you can share experiences, andthe cornerstone educational sessions by our top-notch teamofmedical professionals and researchers. And lastly, a dinner anddance with talent show and closing picnic for all attendees.We are grateful to our conference sponsors who generously

underwrite a significant portion of the expenses, allowing usto keep the registration fee well below production costs. Manyof these sponsors design andmanufacture shunts and they willhave models there for you to see and feel.We thank the following sponsors:Aesculap, Inc.Codman, a Johnson & Johnson CompanyMedtronic NeurosurgeryRudi Schulte Research Institute

One of the key ingredients of a great conference is the par-ticipants, andwe invite you to join us in creating our best gath-ering ever. The 11th National Conference onHydrocephalus is“For YOU,” patients, families, friends, caretakers and healthprofessionals.We hope it will be an empowering time for us all.Our conference medical co-chairs are Drs. Mark Luciano andStephen Dombrowski of the Cleveland Clinic.

CONFERENCE REGISTRATION:You can register online. Please go to www.hydroassoc.org. Ifyou are unable to register via the website, please contact ouroffice at 888-598-3789 or e-mail us at: [email protected].

ACCOMMODATIONS:This year’s conferencewill be at the IntercontinentalClevelandHotel and Conference Center. To make your hotel reserva-tions, call 877-707-8999 and mention the HydrocephalusAssociation conference.We have two other hotels available closeby for attendees to choose from. The reservation number is thesame for all three hotels. Attendees must specify they are withthe Hydrocephalus Association conference and their accom-modation preference. The cut-off date for the group block isMay 26.

AIRPORT TRANSPORTATION:Super Express Transportation. Tel.: 877-251-5701Advanced reservation is not required, but is preferred. Therewill be a greeter/welcome desk on the baggage claim level ofthe airport displaying the conference name and information.The table will be staffed from 8 a.m. to 6 p.m., but if you arriveoutside of that time frame, call 877-251-5701 for pick-up. Thecost is $10per person, oneway, including tax and tip. Passengerswith awheelchair exceeding 250 poundsmustmake an advancereservation for a separate car and the cost is $45 eachway.Guestshave the option of prepaying for the roundtrip ($20) when theyarrive at the welcome desk.

FINANCIAL AID:Limited financial aid is available to members of theHydrocephalus Association to cover conference registrationfees. Financial aid is awarded based on need. Please call our of-fice to request a financial aid application form.

CHILDCAREWe are thrilled to announce the availability of childcare dur-ing the conference.

CHILDREN AGES 7-12; $70 PER DAY:Day 1: TheClevelandMuseumofNatural History will providean all-day program for 25 children per day (Friday and Saturday)from 9 a.m. to 5 p.m. The program includes exploration of thetraveling exhibitWildMusic, visits to the planetarium, dinosaurhall, live animals and hands-on activities, including take-homecraft. Transportation to and from themuseum, lunch and snackare included.Day 2: All day entertainment at the Intercontinental with ed-ucation, crafts, games and other fun activities.

CHILDREN AGES 3-6; $80 FOR FRIDAY AND SATURDAY:All day entertainment at the Intercontinental with education,crafts, games and other fun activities. The fee covers Friday andSaturday. Lunch is included.

CONFERENCE SCHEDULE:Sessions begin at 4 p.m. on Thursday, June 17, and concludeat 2 p.m. on Sunday, June 20. Much of the appeal of the con-ference lies in connections and conversations outside of sched-uled sessions.Hydrocephalus is a chronic condition for which there is no

cure. Our patient-centered conferences empower all of us toreach out to programs and services that will meet our needsnow and in the future. We hope you will join us.

IT’S FOR YOU! Pip Marks, Director of Support & Education and Karima Roumila, MPH, Outreach Coordinator


Join us in Cleveland For our 11th National Conference

TheNational Conference onHydrocephalus is our bien-

nial gathering to self-educateand make or renew connec-tions. Join doctors, nurses, par-ents, children, people livingwith hydrocephalus and peo-ple affected by it, as we cele-brate our community.While we strive to keep costs

down for attendees and pro-vide some financial aid for reg-istration, there are other coststo consider, such as airfare andaccommodations. Because ofthe chronic nature of hydro-cephalus, many of us struggletomake endsmeet. Sowe haveput together a tip sheet to give you ideas on identifying sourcesthat might provide financial assistance.

CLUBS/ASSOCIATIONS:It often pays to solicit professional or charitable organizations.Consider non-specific organizations such as the Elks, Kiwanisand Rotary clubs; regional groups, like the Native Sons of theGolden West; and historical, veteran or recreational associa-tions, such as the Daughters of the American Revolution, theVeterans of ForeignWars and the YMCA. These large organiza-tions often promote raising money for worthy causes, includ-ing those involving chronic illness.Here is a list of clubs and organizations to get you started.

Keep in mind that these usually have a local chapter, and it’sbest to deal with them at that level.www.kiwanis.orgwww.elks.orgwww.lionsclub.orgwww.mooseintl.orgwww.rotary.orgwww.nsgw.org

REGIONAL CENTERSRegional Centers are also a great resource for parents. Theseare state-run organizations set up to assist parents with chil-drenwho are at-risk developmentally. As the conference is gearedto providing information for these children, Regional Centersare another potential source of financial assistance.

HOP ON BOARD AT THE HA CONFERENCE: Tips on how you can afford it!Tom Smith, Outreach&Media Liaison

LOCAL FAMILY RESOURCECENTERS ANDNONPROFITS FORMEDICAL CONDITIONSThere aremany conditions thatare either concomitant, relatedor causal to hydrocephalus.Consider approaching a non-profit related to this other con-dition to see if it provides fund-ing to promote better educa-tion or quality of life.

TREATMENT CLINICSSome clinics provide grants tofurther the education of pa-tients with chronic conditions.

CREATE YOUR OWN OPPORTUNITYCreate an event and invite friends, family and people from yourcommunity. Let them knowwhat the funds raised will be usedfor, why it’s important and howmuch their contribution is ap-preciated. Perhaps a community group, like the local chapterof the Boy Scouts, would be willing to assist.

Hydrocephalus and YOU:A Symposium for Healthcare Professionals

Treating hydrocephalus requires a multi-disciplinary teameffort, involving primary care physicians, nurses, thera-

pists, neurologists, neurosurgeons, psychologists and oth-ers. Knowing how these professionals interact with eachother in the overall treatment of hydrocephalus leads tobetter patient care.This half-day symposium will be held during our annual

conference on June 17 and will cover all aspects of hydro-cephalus: from the basics of anatomy and physiology, toidentifying the condition, treatment options, long termmanagement and other disorders associated with hydro-cephalus. The goal is to provide healthcare professionalswith the tools they need to help patients with hydrocephalusimprove their quality of life.

Open to Healthcare Professionals Only!


The following summaries are a smallsample of research papers, which have

appeared in peer-reviewed medical andscientific journals last year. Due to spacelimitations resulting from the abundanceof exciting developments, we have col-lapsed the abstracts to include only theconclusions. We have categorized theminto six groups: adult including normalpressure hydrocephalus, basic science,ETV (endoscopic third ventriculostomy),pediatric, shunt and other.For more information on these and

other studies, visit our website at:www.hydroassoc.org, and go to “Re -search and Advocacy” on the left paneland then find “Medical Journal Articles.”

ADULT INCLUDING NORMALPRESSURE HYDROCEPHALUS (NPH)

A prospective study of cerebral blood flow andcerebrovascular reactivity to acetazolamidein 162 patients with idiopathic normal pres-sure hydrocephalus. Chang, Chia-Cheng;Asada, Hiroyuki; Mimura, Toshiro; Suzuki,Shinichi. Journal of Neurosurgery, 2009 Sep,111(3):610-7; Department of Neurosurgery,Yokohama Minami Kyosai Hospital, Yokohama,Japan.

Both cerebral blood flow (CBF) and cere-brovascular reactivity (CVR) decrease withthe development of NPH, suggesting thathemodynamic ischemia may be responsi-ble for manifestation of the symptoms.Impaired CVR and reduced CBF with thedevelopment of symptoms can be proposedas diagnostic criteria for idiopathic NPH.

Cerebrospinal fluid drainage and dynamics inthe diagnosis of normal pressure hydro-cephalus. Woodworth, Graeme F; McGirt,Matthew J; Williams, Michael A; Rigamonti,Daniele. Neurosurgery, 2009 May, 64(5):919-25; Department of Neurosurgery, JohnsHopkins Hospital, Baltimore, MD.

In this study of 51 INPH patients who un-derwent CSF pressure (Pcsf) monitoringwith waveform analysis and CSF drainagefollowed by shunt surgery, there was nocorrelation between specific Pcsf wave char-acteristics and objective symptomatic im-provement after shunt placement. Pcsfmonitoring with B-wave analysis con-tributes little to the diagnostic dilemmawith INPH patients. Clinical response tocontinuous CSF drainage over a 72-hour

period suggests a high likelihood of shuntresponsiveness.

Cognitive dysfunction in normal pressure hy-drocephalus (NPH): a case report and re-view of the literature. Zarrouf, Fahd; Griffith,James; Jesse, Jane. The West Virginia MedicalJournal, 2009 Mar-Apr, 105(2):22, 24-6;Medicine-Psychiatry Residency, WVU,Charleston, WV.

A review of the literature about NPH patho-physiology, evaluation, its association withseveral psychiatric and cognitive symptoms,available treatment outlines and suggest-ed future research directions.

Glaucomatous disease in patients with nor-mal pressure hydrocephalus. Chang, Ta C;Singh, Kuldev. Journal of Glaucoma, 2009Mar, 18(3):243-6; Department of Ophthalm -ology, Stanford University Medical Center, CA.

We found the prevalence of a glaucoma di-agnosis to be threefold greater in patientswith NPH as compared with age-matchednon-NPH controls with hydrocephalus.

Hyponatraemia in patients with normal pres-sure hydrocephalus. Chou, C-Y; Liu, J-H;Wang, S-M; Yang, Y-F; Lin, H-H; Liu, Y-L;Huang, C-C. International Journal of ClinicalPractice, 2009 Mar, 63(3):457-61; Depart -ment of Internal Medicine, China MedicalUniversity Hospital, North District, Taichung,Taiwan.

Hyponatraemia is not uncommon in pa-tients with NPH. Physicians should beaware of this complication and obtain nec-essary laboratory examination for early de-tection of hyponatraemia.

Noninvasive biomarkers in normal pressurehydrocephalus: evidence for the role of neu-roimaging. Tarnaris, Andrew; Kitchen, NeilD; Watkins, Laurence D. Journal ofNeurosurgery, 2009 May, 110(5):837-51;Victor Horsley Department of Neurosurgery,National Hospital for Neurology andNeurosurgery, London, U.K.

There is at present Level A evidence for us-ing MR spectroscopy in patients with sec-ondary NPH, and Level B evidence for us-ing SPECT and phase-contrast MR imag-ing to select patients with idiopathic NPHfor shunt placement.

Normal pressure hydrocephalus. Finney, GlenR. International Review of Neurobiology, 2009,84:263-81; Memory and Cognitive Disorders

Program, University of Florida Department ofNeurology, Gainesville, FL.

Modern criteria recognize a wider range ofdiagnostic criteria, and new positive andnegative prognostic indicators for treat-ment benefit have been discovered, thoughthe mainstay remains initial drainage of alarge volume of cerebrospinal fluid andmonitoring for clinical improvement.

Relationship between ventricular morpholo-gy and aqueductal cerebrospinal fluid flowin healthy and communicating hydro-cephalus. Chiang, William W; Takoudis,Christos G; Lee, Sang H; Weis-McNulty,Annette; Glick, Roberta; Alperin, Noam.Investigative Radiology, 2009 Apr, 44(4):192-9; Departments of Radiology, University ofIllinois, Chicago, IL.

Aqueductal CSF flow is strongly correlat-ed with ventricular morphology, especial-ly with the total ventricular volume and thethird ventricle width, but not with the test-ed hydrodynamic parameters. In addition,aqueductal stroke volume (ASV) is linear-ly correlated with aqueductal lumen area,suggesting that the aqueductal CSF flowcharacteristics can be explained by oscillat-ing pressure differences on the order of lessthan 0.01 mmHg. These findings may ex-plain why a standalone ASV is a poor diag-nostic marker and an insensitive indicatorof shunt outcome in idiopathic normalpressure hydrocephalus.

The longitudinal profile of CSF markers dur-ing external lumbar drainage. Tarnaris, A;Toma, A K; Chapman, M D; Petzold, A;Kitchen, N D; Keir, G; Watkins, L D. Journalof Neurology, Neurosurgery, and Psychiatry,2009 Oct, 80(10):1130-3.; Victor HorsleyDepartment of Neurosurgery, National Hospitalfor Neurology and Neurosurgery, London, U.K.

Evidence is provided that external lumbardrainage (ELD) is producing measurablechanges in the CSF composition of patientswith iNPH. The paper discusses how suchchanges may be implicated in the patho-physiology of the condition.

Treatment of hydrocephalus in adults.Hamilton, Mark G. Seminars in PediatricNeurology, 2009 Mar, 16(1):34-41; Depart -ment of Clinical Neurosciences, University ofCalgary, Canada.

A comprehensive adult hydrocephalus clin-ic model is described and recommended toadvance our understanding of this diverse

HIGHLIGHTS IN HYDROCEPHALUS RESEARCH

(Continued on page 6.)

patient population, which will ultimatelylead to the development and provision ofa better standard of patient care.

Upper extremity motor measures of Tap Testresponse in normal pressure hydrocephalus.Tsakanikas, Diamanto; Katzen, Heather;Ravdin, Lisa D; Relkin, Norman R. ClinicalNeurology and Neurosurgery, 2009 Nov,111(9):752-7.; Department of Neurology andNeuroscience, Weill Medical College of CornellUniversity, New York, NY.

Our data suggest that measures of upperextremity motor functions may be usefulas measures of Tap Test response in pa-tients with iNPH. These upper extremitymotor tasks can be rapidly administered(<5 min) in clinical practice and may pro-vide an additional dimension beyond gaitand cognition for evaluating response toLP.

Voxel-based analysis of Tc-99m ECD brainperfusion SPECT in patients with normalpressure hydrocephalus. Yoon, Bora; Yang,Dong-Won; Shim, Yong-Soo; Chung, Sung-Woo; Ahn, Kook-Jin; O, Joo-Hyun; Kim, Sung-Hoon; Sohn, Hyung-Sun; Chung, Soo-Kyo;Chung, Yong-An. Applied Radiation andIsotopes, 2009 Jul-Aug;67(7-8):1377-81,Catholic University of Korea, Seoul, SouthKorea.

In statistical probabilistic brain anatomicmap (SPAM) analysis, regional cerebralblood flow (rCBF) reduction was observedin bilateral prefrontal area, anterior, pos-terior cingulate gyri and caudate nuclei. Wehave found that rCBF changes occurredpredominantly in prefrontal and subcorti-cal areas, the changes were associated withfrontal subcortical circuit, and the affect-ed frontal subcortical circuit may contributeto the cognitive decline seen in the iNPHpatients. The reduction of rCBF and clin-ical cognitive impairment are closely con-nected in patients with iNPH.

Changes in aqueductal CSF stroke volume inshunted patients with idiopathic normal-pressure hydrocephalus. Scollato, A; Gallina,P; Gautam, B; Pellicanò, G; Cavallini, C;Tenenbaum, R; Di Lorenzo, N. AJNR.American Journal of Neuroradiology, 2009Sep, 30(8):1580-6.; Department ofNeurosurgery, University of Florence, Italy.

Aqueductal CSF stroke volume (ACSV) de-creases in all patients in whom the ventricu-

loperitoneal shunt (VPS) system worksproperly, with the rate of ACSV decreasebeing higher in the patients who show clin-ical improvement. Postoperative ACSV in-crease suggests shunt malfunction. A pre-cipitous drop of ACSV values after VPS maybe the consequence of increased drainageand herald the occurrence of subdural flu-id collection (SDFC).

Repetitive lumbar punctures as treatment fornormal pressure hydrocephalus. Lim, T S;Yong, S W; Moon, S Y. European Neurology,2009, 62(5):293-7; Department of Neurology,Ajou University School of Medicine, Yeongtong-Gu, Suwon, South Korea.

Our study showed that some NPH patientscould maintain favorable courses for at leastone year after LP without shunt operation.Repeated LP could be an alternative treat-ment in selected NPH patients.

BASIC SCIENCE

A mathematical model of blood, cerebrospinalfluid and brain dynamics. Linninger, AndreasA; Xenos, Michalis; Sweetman, Brian; Ponkshe,Sukruti; Guo, Xiaodong; Penn, Richard. Journalof Mathematical Biology, 2009 Dec,59(6):729-59; Laboratory for Product andProcess Design (LPPD), Department ofBioengineering and Chemical Engineering,University of Illinois at Chicago, IL.

Using first principles of fluid and solid me-chanics a comprehensive model of humanintracranial dynamics is proposed. Thecompartmental model predicts intracra-nial pressure gradients, blood and CSFflows and displacements in normal andpathological conditions like communicat-ing hydrocephalus.

A novel mouse model reveals that polycystin-1 deficiency in ependyma and choroid plexusresults in dysfunctional cilia and hydro-cephalus. Wodarczyk, Claas; Rowe, Isaline;Chiaravalli, Marco; Pema, Monika; Qian, Feng;Boletta, Alessandra. PLoS One, 2009,4(9):e7137; Dulbecco Telethon Institute (DTI)at Dibit, San Raffaele Scientific Institute, Milan,Italy.

We observed hydrocephalus formation bothin the ubiquitous knock-out embryos andin newborn mice with conditional inacti-vation of the Pkd1 gene in the brain. Wepropose that the role of PC-1 in the braincilia might be to prevent hydrocephalus, apreviously unrecognized role for this recep-tor and one that might have important im-

plications for other genetic or sporadic dis-eases.

Characterization of juvenile and young adultmice following induction of hydrocephaluswith kaolin. Lopes, Luiza da Silva; Slobodian,Ili; Del Bigio, Marc R. Experimental Neurology,2009 Sep, 219(1):187-96; Departamento deCirurgia e Anatomia, Faculdade de Medicinade Ribeirão Preto, Universidade de São Paulo,Brazil.

Hydrocephalus induced by percutaneousinjection of kaolin in juvenile and youngadult mice is feasible. The associatedperiventricular alterations are essentiallythe same as those reported in rats of com-parable ages.

Congenital hydrocephalus associated with ab-normal subcommissural organ in mice lack-ing huntingtin in Wnt1 cell lineages. Dietrich,Paula; Shanmugasundaram, Revathi; Shuyu,E; Dragatsis, Ioannis. Human MolecularGenetics, 2009 Jan 1, 18(1):142-50; Depart -ment of Physiology, University of Tennessee,Health Science Center, Memphis, TN.

Hydrocephalus in mice lacking htt in Wnt1cell lineages is associated with increase inCSF production by the choroid plexus andabnormal subcommissural organ.

Development of a theoretical framework foranalyzing cerebrospinal fluid dynamics.Cohen B, Voorhees A, Vedel S, Wei T.Cerebrospinal Fluid Res. 2009 Sep 22;6:12;Mechanical, Aerospace and NuclearEngineering, Rensselaer Polytechnic Institute,110 8th Street, Troy, NY.

Control volume analysis provides a frame-work to guide the type and location of meas-urements, and a way to interpret the result-ing data within a fundamental fluid physicsanalysis.

Dissociation between vascular endothelialgrowth factor receptor-2 and blood vesseldensity in the caudate nucleus after chron-ic hydrocephalus. Deshpande, Abhishek;Dombrowski, Stephen M; Leichliter, Anna;Krajcir, Natalie; Zingales, Nicholas; Inoue,Masahiro; Schenk, Soren; Fukamachi, Kiyotaka;Luciano, Mark G. Journal of Cerebral BloodFlow and Metabolism, official journal of theInternational Society of Cerebral Blood Flowand Metabolism, 2009 Nov, 29(11):1806-15; Department of Neurological Surgery, CSF

HIGHLIGHTS IN HYDROCEPHALUS RESEARCH (continued)


ADULTS/NPH (Continued)

Physiology Laboratory, Neurological Institute,Cleveland Clinic, Cleveland, OH.

Changes in cerebrospinal fluid ventricularvolume and pressure, as well as in CBF didnot correlate with either VEGFR-2 or BVd.These observed findings suggest that de-structive forces may outweigh angiogenicforces and possibly show a disassociationbetween VEGFR-2 and BV expressions.

Gray matter metabolism in acute and chron-ic hydrocephalus. Kondziella, D; Eyjolfsson,E M; Saether, O; Sonnewald, U; Risa, O.Neuroscience, 2009 Mar 17, 159(2):570-7;Department of Neuroscience, NorwegianUniversity of Science and Technology,Trondheim, Norway.

If confirmed in humans, early detection ofglutamatergic disturbances and lactate ac-cumulation using in vivo(1)H MRS mightserve as an indication for surgical treatmentof hydrocephalus before irreversible neu-ronal damage develops.

Intraventricular injection of antibodies tobeta1-integrins generates pressure gradi-ents in the brain favoring hydrocephalusdevelopment in rats. Nagra, Gurjit; Koh,Lena; Aubert, Isabelle; Kim, Minhui; Johnston,Miles. American Journal of Physiology.Regulatory, integrative and comparative phys-iology, 2009 Nov, 297(5):R1312-21; BrainSciences Program and Department ofLaboratory Sunnybrook Health Sciences Centre,University of Toronto, Ontario, Canada.

We conclude that modulation/disruptionof beta(1)-integrin-matrix interactions inthe brain generates pressure gradients fa-voring ventricular expansion, suggesting anovel mechanism for hydrocephalus devel-opment.

Low levels of amyloid-beta and its transportersin neonatal rats with and without hydro-cephalus. Deren, Kelley E; Forsyth, Jennifer;Abdullah, Osama; Hsu, Edward W; Klinge,Petra M; Silverberg, Gerald D; Johanson,Conrad E; McAllister, James P. CerebrospinalFluid Research, 2009, 6:4. Epub: 2009 May26. Department of Neurosurgery, Division ofPediatric Neurosurgery, Primary Children’sMedical Center and the University of Utah,Salt Lake City, UT.Neonatal rats with and without hydro-

cephalus had low expression of Abeta andits transporters when compared to adultrats with hydrocephalus. No statistical dif-ferences were observed in Abeta and its

transporters between the control and hy-drocephalic neonatal animals.

Reissner’s fibre proteins and p73 variationsin the cerebrospinal fluid and subcommis-sural organ of hydrocephalic rat. Carmona-Calero, E M; González-Marrero, I; González-Toledo, J M; Castañeyra-Ruiz, A; De Paz-Carmona, H; Castañeyra-Ruiz, L;Fernández-Rodriguez, P; Ruiz-Mayor, M L;Castañeyra-Perdomo, A. Anatomia, Histologia,Embryologia, 2009 Aug, 38(4):282-5;Departamento de Anatomía, Facultad deMedicina, Universidad de La Laguna, Tenerife,Islas Canarias, Spain.

Hydrocephalus produces a decrease in thesecretions of the SCO and an absence ofRF and a decrease in p73 and RF proteinsin the CSF.

Resonant and notch behavior in intracranialpressure dynamics. Wagshul, Mark E; Kelly,Erin J; Yu, Hui Jing; Garlick, Barbara;Zimmerman, Tom; Egnor, Michael R. JNeurosurg Pediatr, 2009 May, 3(5):354-64;Department of Radiology, Stony BrookUniversity, Stony Brook, NY.

This transfer function behavior is charac-teristic of a resonant notch system. Thismay represent a component of the intracra-nial Windkessel mechanism, which pro-tects the microvasculature from arterialpulsatility. The impairment of this reso-nant notch system may play a role in thealtered pulse pressure in conditions suchas hydrocephalus and traumatic brainswelling. New models of intracranial dy-namics are needed for understanding thefrequency-sensitive behavior elucidated inthese studies and could open a path for de-velopment of new therapies that are gearedtoward addressing the pulsation dysfunc-tion in pathological conditions, such as hy-drocephalus and traumatic brain injury, af-fecting ICP and flow dynamics.

SCO-ping out the mechanisms underlying theetiology of hydrocephalus. Huh, Michael S;Todd, Matthew A M; Picketts, David J.Physiology (Bethesda, MD), 2009 Apr,24:117-26; Regenerative Medicine Program,Ottawa Health Research Institute, Canada.

We review how altered development andfunction of the SCO and vel cells con-tributes to hydrocephalus.

Sporadic obstructive hydrocephalus in Aqp4null mice. Feng, Xuechao; Papadopoulos,Marios C; Liu, Jun; Li, Lihua; Zhang, Di; Zhang,

Hongguo; Verkman, A S; Ma, Tonghui. Journalof Neuroscience Research, 2009 Apr,87(5):1150-5; Membrane Channel ResearchLaboratory and Key Laboratory for AppliedStatistics of MOE, Northeast Normal University,Changchun, P.R. China.

Our studies establish Aqp4 deletion as apredisposing factor for the development ofcongenital obstructive hydrocephalus inmice. We suggest that AQP4 polymor-phisms might also contribute to the devel-opment of aqueduct stenosis in humans.

The morphology and biochemistry of nanos-tructures provide evidence for synthesis andsignaling functions in human cerebrospinalfluid. Harrington MG, Fonteh AN, OborinaE, Liao P, Cowan RP, McComb G, Chavez JN,Rush J, Biringer RG, Hühmer AF. CerebrospinalFluid Res. 2009 Sep 7;6:10; MolecularNeurology, Huntington Medical ResearchInstitutes, Pasadena, CA.

Unique morphology and biochemistry fea-tures of abundant and discrete membrane-bound CSF nanostructures are described.Prostaglandin H synthase activity, essen-tial for prostanoid production and previ-ously unknown in CSF, is localized tonanospheres. Considering CSF bulk flowand its circulatory dynamics, we proposethat these nanostructures provide signal-ing mechanisms via volume transmissionwithin the nervous system that are for slow-er, more diffuse and of longer duration thansynaptic transmission.

The physics of hydrocephalus. Penn, RichardD; Linninger, Andreas. Pediatric Neurosurgery,2009, 45(3):161-74; Department of Surgery,University of Chicago, IL.

The complications and poor performanceof shunts based on pressure-sensitive valvesare explained and a system of feedback con-trol is suggested as a solution.

Ventricular dilation and elevated aqueductalpulsations in a new experimental model ofcommunicating hydrocephalus. Wagshul, ME; McAllister, J P; Rashid, S; Li, J; Egnor, MR; Walker, M L; Yu, M; Smith, S D; Zhang,G; Chen, J J; Benveniste, H. ExperimentalNeurology, 2009 Jul, 218(1):33-40; Depart -ment of Radiology, Health Science Center, StonyBrook University, Stony Brook, NY.

Aqueductal flow can be measured in the ratusing high-field MRI and basal cistern-in-duced CH and is associated with an imme-diate change in CSF pulsatility. At the same




time, our results highlight the complex na-ture of aqueductal pulsation and its rela-tionship to ventricular dilation.

Coupling poroelasticity and CFD for cere-brospinal fluid hydrodynamics. Tully, Brett;Ventikos, Yiannis. IEEE Transactions on Bio-medical Engineering, 2009 Jun, 56(6):1644-51; Fluidics and Biocomplexity Group, Instituteof Biomedical Engineering and Department ofEngineering Science, University of Oxford, U.K.

Preliminary findings demonstrate clearlythe importance that the fluidic-poroelas-tic coupling plays: ventricular enlargementis significantly smaller with local stenosispatterns and almost all of the observablepressure drop occurs across the stenosis.

Haploinsufficiency of the murine polycombgene Suz12 results in diverse malforma-tions of the brain and neural tube. Miró,Xavier; Zhou, Xunlei; Boretius, Susann;Michaelis, Thomas; Kubisch, Christian; Alvarez-Bolado, Gonzalo; Gruss, Peter. Disease Models& Mechanisms, 2009 Jul-Aug, 2(7-8):412-8.; Max Planck Institute of BiophysicalChemistry, Department of Molecular CellBiology, Göttingen,, Germany.

Although the involvement of polycombgenes in human disease is starting to berecognized, this is the first demonstrationof their role in nervous system malforma-tions. Our work strongly suggests that brainmalformations such as Chiari malforma-tion (CM) can result from altered epigenet-ic regulation of genes involved in cell pro-liferation in the brain.

Normal and hydrocephalic brain dynamics: therole of reduced cerebrospinal fluid reab-sorption in ventricular enlargement.Linninger, Andreas A; Sweetman, Brian; Penn,Richard. Annals of Biomedical Engineering,2009 Jul, 37(7):1434-47. Laboratory forProduct and Process Design, Department ofBioengineering, University of Illinois at Chicago,IL.By increasing the value for reabsorption

resistance in the subarachnoid villi, ourmodel predicts that the poroelasticparenchyma matrix will be drained and theventricles enlarge despite small transman-tle pressure gradients during the transi-tional phase. The poroelastic simulationthus provides a plausible explanation onhow reabsorption changes could be respon-

sible for enlargement of the ventricles with-out large transmantle pressure gradients.

ETV

A pediatric experience with endoscopic thirdventriculostomy for hydrocephalus. Bullivant,Kelly J; Hader, Walter; Hamilton, Mark.Canadian Journal of Neuroscience Nursing,2009, 31(2):16-9; Alberta Children’sHospital, Calgary, Canada.

A case report comparing neurocognitivetesting before and after ETV. An addition-al case report of a patient with a sponta-neous third ventriculostomy will help il-lustrate our understanding of the naturalhistory of hydrocephalus.

Cine phase-contrast MR images failed to pre-dict clinical outcome following ETV. Di,Xiao; Ragab, M; Luciano, Mark G. CanadianJournal of Neurological Sciences. Le journalcanadien des sciences neurologiques, 2009 Sep,36(5):643-7;Department of NeurologicalSurgery, Neurological Institute, Cleveland Clinic,OH.

PC MRI cine flow failed to demonstrate sig-nificant differences between successful andfailed ETV groups. This indicates in addi-tion to achieving an adequate fenestration,CSF pathways beyond the basal cisternsaround the brain stem and CMJ may playan essential role in achieving ETVsuccess.Endoscopic options in children: ex-perience with 134 procedures.

Endoscopic options in children: experience with134 procedures. Oertel, Joachim M K;Baldauf, Joerg; Schroeder, Henry W S; Gaab,Michael R. J Neurosurg Pediatr, 2009 Feb,3(2):81-9; Department of Neurosurgery,Nordstadtkrankenhaus Hannover, Germany.

Overall, endoscopy can be considered safeand effective in children. Based on the au-thors’ data, acute hydrocephalus cases suchas those caused by tumors are the best can-didates for endoscopic CSF flow restora-tion. Interestingly, cyst openings to the ven-tricles or cisterns were the most successfulendoscopic techniques with the lowest com-plication rate. Aqueductoplasty should bereserved for selected cases. Finally, the suc-cess rate of endoscopic techniques remainspoor in infants <6 months of age; this wasnot only true of ETV, but also other tech-niques such as septostomy and aqueduc-toplasty.

Endoscopic third ventriculostomy in the treat-ment of childhood hydrocephalus. Kulkarni,Abhaya V; Drake, James M; Mallucci, ConorL; Sgouros, Spyros; Roth, Jonathan; Constantini,Shlomi; Canadian Pediatric Neurosurgery StudyGroup. Journal of Pediatrics, 2009 Aug,155(2):254-9; Hospital for Sick Children,Toronto, Ontario, Canada.

Children most likely to succeed with ETVcan now be accurately identified and sparedthe long-term complications of CSF shunt-ing.

Endoscopic third ventriculostomy versus ven-triculoperitoneal shunt in pediatric patients:a decision analysis. Drake, James M; Kulkarni,Abhaya V; Kestle, John. Child’s Nervous System:ChNS : official journal of the InternationalSociety for Pediatric Neurosurgery, 2009 Apr,25(4):467-72; Division of Neurosurgery,University of Toronto, Ontario, Canada.

Age is a major determinant of outcomefrom CSF diversion with worse outcomesin young patients. QALY estimates for ei-ther ETV or shunt are similar at one year.

Endoscopic third ventriculostomy: predictingoutcome with phase-contrast MR imaging.Stivaros, Stavros M; Sinclair, Deborah;Bromiley, Paul A; Kim, Jieun; Thorne, John;Jackson, Alan. Radiology, 2009 Sep,252(3):825-32; Department of ImagingScience, Wolfson Molecular Imaging Centre,University of Manchester, U.K.

ETV induces changes in brain volume andcerebral blood flow (CBF) that can be pre-dicted by using simple metrics. These pilotresults support a formal trial of these tech-niques in a larger prospective study.

Hemorrhagic complications of ventriculosto-my placement: a meta-analysis. Binz, DanielD; Toussaint, L Gerard; Friedman, JonathanA; Neurocrit Care 2009; 10(2):253-6. Epub2009 Feb 18; Departments of Surgery,Neuroscience and Experimental Therapeutics,Texas A&M Health Science Center College ofMedicine, College Station, TX.

The overall hemorrhage risk associated withventriculostomy placement based on theexisting literature is 5.7%. Clinically signifi-cant hemorrhage due to ventriculostomyis less than 1%.

Neurocognitive outcome after endoscopic thirdventriculocisterostomy in patients with ob-structive hydrocephalus. Lacy, Maureen;Oliveira, Martin; Austria, Emily; Frim, MDavid. Journal of the International


BASIC SCIENCE (Continued)


Neuropsychological Society : JINS, 2009 May,15(3):394-8; Department of Psychiatry,University of Chicago Medical Center, IL.

The present study revealed persistent cog-nitive inefficiencies in memory and execu-tive domains in patients post-ETV inter-vention.

Quality of life in obstructive hydrocephalus:endoscopic third ventriculostomy comparedto cerebrospinal fluid shunt. Kulkarni AV,Hui S, Shams I, Donnelly R. Childs Nerv Syst.2009 Aug 28; Divisions of Neurosurgery andPsychology, Hospital for Sick Children, Toronto,Ontario, Canada.

This is the first study to provide a mean-ingful comparison of QOL after ETV andshunt in children. These preliminary re-sults suggest that there is no obvious dif-ference in QOL after ETV and shunt.

The role of endoscopic third ventriculostomyin adult patients with hydrocephalus.Jenkinson, Michael D; Hayhurst, Caroline; Al-Jumaily, Mohammed; Kandasamy, Jothy; Clark,Simon; Mallucci, Conor L. J Neurosurg. 2009May; 110(5):861-6; Department ofNeurosurgery, Walton Centre for Neurologyand Neurosurgery, Liverpool, U.K.

The success rate of ETVs in adults is com-parable, if not better, than in children. Inaddition to the well-defined role of ETV inthe treatment of hydrocephalus caused bytumors and aqueduct stenosis, ETV mayalso have a role in the management of CM-I, LOVA, persistent shunt infection, andIVH resistant to other CSF diversion pro-cedures.

Long-term results of a second endoscopic thirdventriculostomy in children: retrospectiveanalysis of 40 cases. Peretta, Paola; Cinalli,Giuseppe; Spennato, Pietro; Ragazzi, Paola;Ruggiero, Claudio; Aliberti, Ferdinando;Carlino, Christian; Cianciulli, Emilio.Neurosurgery, 2009 Sep, 65(3):539-47;Department of Pediatric Neurosurgery, ReginaMargherita Children’s Hospital, Turin, Italy.

A second ETV can be performed with a rea-sonable chance of restoring patency of thestoma and avoiding placement of an ex-trathecal shunt. Every effort should be madeto detect subarachnoid adhesions in thecistern on preoperative imaging study toselect potential candidates and avoid un-necessary procedures.

The management of hydrocephalus in childrenwith posterior fossa tumours: the role of

pre-resectional endoscopic third ventricu-lostomy. Bhatia, Robin; Tahir, Mohammed;Chandler, Christopher L. Pediatric Neuro -surgery, 2009, 45(3):186-91; Departmentof Neurosurgery, Kings College Hospital,London, U.K.

The use of pre-resectional ETV at this in-stitution is an effective and safe procedurewith a high success rate at up to 7.5 yearsof follow-up. We believe that all pediatricneurosurgical institutions should reviewtheir practice regarding hydrocephalus as-sociated with posterior fossa tumors in thelight of the controversy surrounding peri-operative CSF diversion.

PEDIATRIC

External ventricular drains in pediatric pa-tients. Ngo, Quang N; Ranger, Adrianna;Singh, Ram N; Kornecki, Alik; Seabrook, JamieA; Fraser, Douglas D. Pediatr Crit Care Med.2009 May;10(3):346-51; Department ofPaediatrics, University of Western Ontario,Canada.

EVDs were placed for traumatic brain in-jury (TBI), ventriculoperitoneal shunt fail-ure and new-onset hydrocephalus. The over-all complication rate was 26%.Complication rates were similar in TBI andhydrocephalus patients, and with EVDs in-serted in either the pediatric critical careunit (PCCU) or operating room (OR).Prophylactic antibiotics or antimicrobial-impregnated catheters directed against co-agulase-negative Staphylococcus may re-duce EVD infections.

Risk factors of congenital hydrocephalus: a10 year retrospective study. VanLandingham, M; Nguyen, T V; Roberts, A;Parent, A D; Zhang, J . Journal of Neurology,Neurosurgery, and Psychiatry, 2009 Feb,80(2):213-7; Department of Neurosurgery,University of Mississippi Medical Center,Jackson, MS.

A number of key risk factors have been iden-tified to be strongly associated with the de-velopment of congenital hydrocephalus inan infant. The prevalence of familial pat-terns of inheritance for congenital hydro-cephalus suggests a broader role for genet-ic factors in the pathogenesis of congeni-tal hydrocephalus.

Optic nerve sheath ultrasound in the assess-ment of paediatric hydrocephalus. McAuley,David; Paterson, Anne; Sweeney, Louise. Child’sNervous System : ChNS : official journal of the

International Society for Pediatric Neurosurgery,2009 Jan, 25(1):87-90; Paediatric Neuro -surgery, Royal Belfast Hospital for Sick Children,Belfast, Northern Ireland.

Transorbital ultrasound is a reproducible,non-invasive technique for the assessmentof optic nerve sheath diameter and is welltolerated in children. Our series revealedasymptomatic baseline value higher thanin previous reports. Variation from indi-vidual case asymptomatic baseline was themost sensitive variable in the series in de-termining development of hydrocephalus.This technique is felt to be a useful adjunctin the assessment of hydrocephalus in thepediatric neurosurgical population.

A review of the current treatment methodsfor posthaemorrhagic hydrocephalus of in-fants. Shooman, David; Portess, Howard;Sparrow, Owen. Cerebrospinal Fluid Research,2009, 6:1. Department of Neurosurgery,Wessex Neurological Centre, SouthamptonGeneral Hospital, U.K.

Overall, there is still no definitive algorithmfor the treatment of PHH or prevention ofshunt dependence. New therapeutic ap-proaches in neonatal care, including thoseaimed at pre-empting PHH, offer the besthope of improving neurodevelopmentaloutcomes.

Abnormal optic disc and retinal vessels in chil-dren with surgically treated hydrocephalus.

Andersson, S; Hellström, A. British Journal ofOphthalmology, 2009 Apr, 93(4):526-30;Department of Ophthalmology, The Queen SilviaChildren’s Hospital, Sahlgrenska UniversityHospital/Ostra, Göteborg, Sweden.Hydrocephalus is associated with subnor-mal optic disc and rim areas and an abnor-mal vascular pattern, indicating a pre/peri-natal disturbance of the development ofthese structures. A promising finding isthat the frequency of optic atrophy in thepresent study was lower than previously re-ported, most likely reflecting improved peri-natal care and better regulation of the in-tracranial pressure.

Addressing a folate imbalance in fetal cere-brospinal fluid can decrease the incidenceof congenital hydrocephalus. Cains, Sarah;Shepherd, Andrew; Nabiuni, Mohammad;Owen-Lynch, Penelope Jane; Miyan, Jaleel.Journal of Neuropathology and Experimental




Neurology, 2009 Apr, 68(4):404-16; Facultyof Life Sciences, University of Manchester, U.K.

These results indicate the complexities offolate metabolism in the developing brainand suggest that folate imbalance leadingto hydrocephalus in the hydrocephalicTexas rat fetuses can be treated with ma-ternal folate supplementation, using spe-cific folate metabolites and combinationsthereof.

Visual fixation in Chiari type II malformation.Salman, Michael S; Sharpe, James A; Lillakas,Linda; Dennis, Maureen; Steinbach, Martin J.Journal of Child Neurology, 2009 Feb,24(2):161-5; Section of Pediatric Neurology,Children’s Hospital, University of Manitoba,Winnipeg, Canada.

Chiari type II malformation is not associ-ated with pathological square wave jerks orabnormal saccadic oscillations.

Evaluation of the intellectual skill problemsof hydrocephalic children: a clinical study.Bakar, Emel Erdogan; Bakar, Bülent; Taner,Yasemen Işik; Akalan, Nejat Turk Neurosurg.2009 Jan;19(1):29-35; Ufuk University,Psychology, Ankara, Turkey.

Children with hydrocephalus have muchmore problems with their visuospatial per-ception, material organization and atten-tion (especially encode, focused/execute at-tention and sustain attention); and theseissues could produce adaptive problems intheir social, cultural, behavioral and aca-demic achievement.

Predicting postresection hydrocephalus in pe-diatric patients with posterior fossa tumors.Riva-Cambrin, Jay; Detsky, Allan S; Lamberti-Pasculli, Maria; Sargent, Michael A; Armstrong,Derek; Moineddin, Rahim; Cochrane, DDouglas; Drake, James M. Journal Neurosurg.Pediatr. 2009 May; 3(5):378-85; Departmentof Neurosurgery, Primary Children’s MedicalCenter, University of Utah, Salt Lake City, UT.

A patient’s score on the PreoperativePrediction Rule for Hydrocephalus will al-low improved patient counseling and sur-gical planning by identifying patients athigh risk of developing postresection hy-drocephalus. These patients might selec-tively be exposed to the risks of preresec-tion CSF diversion to improve outcome.

Neuropsychological assessment of attentionin children with spina bifida. Vinck, Anja;

Mullaart, Reinier; Rotteveel, Jan; Maassen,Ben. Cerebrospinal Fluid Research, 2009, 6:6;Department of Medical Psychology, RadboudUniversity Nijmegen Medical Centre,Netherlands.

Assessment of attention functions in chil-dren with SBM (SBM: spina bifida withmyelomeningocele with accompanying hy-drocephalus) by traditional tests may bemisleading, because this paediatric popu-lation with complex cerebral malforma-tions has difficulty with the cognitive andvisual-motor requirements. To control forthese interactions, the use of both tradi-tional and computerized attention tests isrecommended.

A multicenter retrospective comparison of con-version from temporary to permanent cere-brospinal fluid diversion in very low birthweight infants with posthemorrhagic hy-drocephalus. Wellons, John C; Shannon, ChevisN; Kulkarni, Abhaya V; Simon, Tamara D;Riva-Cambrin, Jay; Whitehead, William E;Oakes, W Jerry; Drake, James M; Luerssen,Thomas G; Walker, Marion L; Kestle, John RW; Hydrocephalus Clinical Research Network;Journal Neurosurg. Pediatric. 2009Jul;4(1):50-5; Section of PediatricNeurosurgery, Children’s Hospital of Alabama,Division of Neurosurgery, University of Alabamaat Birmingham, AL.

The use of intermittent tapping of ventric-ular reservoirs in this population appearsto lead to a lower incidence of permanentshunt placement than the use of VSGshunts. The incidence of infection duringtemporization and for the initial six monthsafter conversion appears comparable forboth groups.

L1CAM mutation in association with X-linkedhydrocephalus and Hirschsprung’s disease.Jackson, Sha-Ron; Guner, Yigit S; Woo, Russell;Randolph, Linda M; Ford, Henri; Shin, CathyE. Pediatric Surgery International, 2009 Sep,25(9):823-5; Department of Pediatric Surgery,Children’s Hospital Los Angeles;Keck Schoolof Medicine, University of Southern California,Los Angeles, CA.

The association of HSCR with XLH in thepresence of L1CAM mutations remainsquite interesting because cell adhesion mol-ecules are involved in the proper migrationof neural components throughout the body.

Functional outcomes among premature infantswith intraventricular hemorrhage. Vassilyadi,Michael; Tataryn, Zachary; Shamji,

Mohammed F; Ventureyra, Enrique C G.Pediatric Neurosurgery, 2009, 45(4):247-55; Division of Neurosurgery, Children’sHospital of Eastern Ontario, Ottawa, Canada.

This study describes a large cohort of neona-tal IVH, describing how disease severity af-fects mortality and functional outcome.The overall mortality of nearly 1 in 5 pa-tients is primarily of grade IV patients, withno difference between grade II and gradeIII. Further, patients surviving their hydro-cephalus exhibited no worse functional de-terioration if they required surgical inter-vention.

Anisotropic diffusion properties in infants withhydrocephalus: a diffusion tensor imagingstudy. Yuan, W; Mangano, F T; Air, E L;Holland, S K; Jones, B V; Altaye, M; Bierbrauer,K. AJNR. American Journal of Neuroradiology,2009 Oct, 30(9):1792-8;Department ofRadiology, Cincinnati Children’s HospitalMedical Center and University of CincinnatiCollege of Medicine, Cincinnati, OH.

This retrospective diffusion tensor imag-ing (DTI) study demonstrated significantwhite matter (WM) abnormalities in in-fants with hydrocephalus in both the cor-pus callosum and internal capsule. The re-sults also showed evidence that the impactof hydrocephalus on WM was different inthe corpus callosum and internal capsule.

Prioritizing neurosurgical education for pedi-atricians: results of a survey of pediatricneurosurgeons. Aldana, Philipp R; Steinbok,Paul. J Neurosurg Pediatr, 2009 Oct,4(4):309-16; Lucy Gooding PediatricNeurosurgery Center, University of Florida-Jacksonville, FL.

This survey identified what practicing pe-diatric neurosurgeons perceive to be themost important knowledge deficits of theircolleagues in pediatrics. These perceptionsmay not necessarily be congruent with theperceptions of practicing pediatriciansthemselves; nevertheless, the data from thissurvey may serve to inform conversationsbetween neurosurgeons and planners ofcontinuing medical education for pediatri-cians, pediatrics residency program direc-tors and medical school pediatrics faculty.

Sensitivity of papilledema as a sign of shuntfailure in children. Nazir, Sayeda; O’Brien,Mark; Qureshi, Nazer H; Slape, Lamonda;Green, T J; Phillips, Paul H.; Journal of AA-POS 2009 Feb;13(1):63-6. Epub 2008 Nov20; Department of Ophthalmology, University


PEDIATRIC (Continued)


of Arkansas for Medical Sciences, Little Rock,AR.

Papilledema is not a sensitive sign of shuntfailure. Even children with severe elevationsin intracranial pressure from shunt mal-function may have flat optic disks.Therefore, physicians that evaluate chil-dren with shunts should be aware that anormal optic disk does not preclude shuntmalfunction.

The pediatric neurosurgical patient: the chal-lenge of growing up. Rekate, Harold L.Seminars in Pediatric Neurology, 2009 Mar,16(1):2-8; Division of Neurological Surgery,Barrow Neurological Institute, St. Joseph’sHospital and Medical Center, Phoenix, AZ.

This article explores the causes of these dif-ficulties, which are not uniform across ge-ographic areas, and the need for and chal-lenges of planning the transition of care ofpediatric neurosurgical patients from pe-diatric neurosurgeons to general or adultneurosurgical practices.

Upper limb motor function in young adultswith spina bifida and hydrocephalus. DennisM, Salman MS, Jewell D, Hetherington R,Spiegler BJ, MacGregor DL, Drake JM,Humphreys RP, Gentili F. Childs Nerv Syst.2009 Nov;25(11):1447-53; Program inNeurosciences & Mental Health, The Hospitalfor Sick Children, Toronto, Ontario, Canada.

Young adults with SBM have significantlimitations in upper limb function and aremore disrupted by some challenges whileperforming upper limb motor tasks. Withinthe group of young adults with SBM, up-per spinal lesions compromise motor in-dependence more than lower spinal lesions.

Ventricular reservoirs and ventriculoperitonealshunts for premature infants with posthe-morrhagic hydrocephalus: an institutionalexperience. Willis, Brian; Javalkar,Vijayakumar; Vannemreddy, Prasad; Caldito,Gloria; Matsuyama, Junko; Guthikonda,Bharat; Bollam, Papireddy; Nanda, Anil. JNeurosurg Pediatr, 2009 Feb, 3(2):94-100;Department of Neurosurgery, Louisiana StateUniversity Health Sciences Center-Shreveport,LA.

Birth weight and age are useful parametersin decision making. Preterm neonates withlow birth weights benefit from initial CSFdrainage procedures followed by perma-nent CSF diversion with respect to the num-ber of shunt revisions.

On the changing epidemiology of hydro-cephalus. Massimi, Luca; Paternoster,Giovanna; Fasano, Teresa; Di Rocco, Concezio.Child’s Nervous System : ChNS : official jour-nal of the International Society for PediatricNeurosurgery, 2009 Jul, 25(7):795-800;Paediatric Neurosurgery-Institute of Neuro -surgery, Rome, Italy.

The present study confirmed data from theliterature about the declined incidence ofpaediatric hydrocephalus, which mainly re-sults from the decrease of congenital mal-formations. In spite of the recent advancesin neuroendoscopy and in the shuntingvalve design, the impact of hydrocephalusin the paediatric neurosurgical practice re-mains high.

SHUNT

Accuracy of percutaneous placement of a ven-triculoatrial shunt under ultrasonographyguidance: a retrospective study at a singleinstitution. Metellus, Philippe; Hsu, Wesley;Kharkar, Siddharth; Kapoor, Sumit; Scott,William; Rigamonti, Daniele. Journal ofNeurosurgery, 2009 May, 110(5):867-70;Departments of Neurosurgery, Johns HopkinsHospital, Baltimore, MD.

Percutaneous placement of a VA shunt un-der preoperative radiographic guidance andultrasonographic monitoring is a safe, ef-fective and reliable technique that is sim-ple to learn.

Acute ventriculoperitoneal shunt malfunctionfollowing opening of the spinal subarach-noid space: a case series. Tubbs, R Shane;Pugh, Jeffrey; Acakpo-Satchivi, Leslie; Wellons,John C; Blount, Jeffrey P; Oakes, W Jerry.Child’s Nervous System: 2009 May,25(5):599-600; Section of Pediatric Neuro -surgery, Children’s Hospital, Birmingham, AL.

We theorize that the siphoning effect causedfrom cerebrospinal fluid egress from theopened spinal subarachnoid space result-ed in acute shunt failure. Such alterationsin cerebrospinal fluid flow may precipitatecomplete failure of a shunt that is func-tioning suboptimally. Clinicians should beaware that spinal procedures that violatethe subarachnoid space in shunted hydro-cephalic patients may result in acute shuntfailure. These patients may warrant morecareful observation in the early postoper-ative period, particularly as shunt failuremay compromise spinal wound closures.

Comparison of shunt infection incidence inhigh-risk subgroups receiving antibiotic-im-pregnated versus standard shunts. Parker,Scott L; Attenello, Frank J; Sciubba, Daniel M;Garces-Ambrossi, Giannina L; Ahn, Edward;Weingart, Jon; Carson, Benjamin; Jallo, GeorgeI. Child’s Nervous System 2009 Jan, 25(1):77-83; Department of Neurosurgery, JohnsHopkins Hospital, Baltimore, MD.

The introduction of AIS catheters into ourinstitutional practice has reduced the inci-dence of shunt infection in pediatric pop-ulations at highest risk for infection. AIScatheters are effective instruments to pre-vent peri-operative colonization of CSFshunt components.

Development of pulmonary hypertension inadults after ventriculoatrial shunt implan-tation. Kluge, Stefan; Baumann, Hans Jorg;Regelsberger, Jan; Kehler, Uwe; Koziej, Barbara;Klose, Hans; Greinert, Ulf; Kreymann, Georg;Meyer, Andreas. Respiration; InternationalReview of Thoracic Diseases, 2009, 78(1):30-5; Department of Respiratory Medicine,University Medical Center, Hamburg-Eppendorf, Germany.

Severe pulmonary hypertension can devel-op in adult patients with VA shunts.Therefore, clinicians should consider pul-monary hypertension as a potential causefor respiratory symptoms in patients whohave received VA shunts.

Experiences with a gravity-assisted valve inhydrocephalic children. Clinical article.Haberl, Ernst Johannes; Messing-Juenger,Martina; Schuhmann, Martin; Eymann, Regina;Cedzich, Cornelia; Fritsch, Michael J; Kiefer,Michael; Van Lindert, Eric Johannes; Geyer,Christian; Lehner, Markus; Rohde, Veit; Stroux,Andrea; von Berenberg, Petra. J NeurosurgPediatr, 2009 Sep, 4(3):289-94; SABPädiatrische Neurochirurgie der Charité-Universitätsmedizin, Berlin, Germany.

Compared with nongravitational shunt de-signs, a GAV does not substantially affectthe early complication rate. Valve-preserv-ing shunt revisions do not increase the riskof subsequent valve failure and thereforeshould not be defined as an end point instudies on valve design. A significant im-pact of any well-established valve design onthe early complication rate in shunt sur-gery is not supported by any current data;therefore, this correlation should be dis-missed. As overdrainage-related complica-tions have been shown to occur late, the




presumed advantages of a pediatric GAVremain to be shown in a long-term study.

First experiences with an adjustable gravita-tional valve in childhood hydrocephalus.Rohde, Veit; Haberl, Ernst-Johannes; Ludwig,Hans; Thomale, Ulrich-W. J Neurosurg Pediatr,2009 Feb, 3(2):90-3; Department ofNeurosurgery, Georg-August University,Goettingen, Germany.

With an overall success rate of 88.7%, thefirst experiences with the ProGAV in child-hood hydrocephalus are promising and jus-tify its further use in the pediatric popula-tion.

Gravitational valves in supine patients withventriculo-peritoneal shunts. Deininger,Martin H; Weyerbrock, Astrid. ActaNeurochirurgica, 2009 Jun, 151(6):705-9;Department of Neurosurgery, University ofFreiburg Medical School, Freiburg, Germany.

In the subgroup of bedridden patients withventriculo-peritoneal shunts and gravita-tional valves, upright posture is a prereq-uisite for proper cerebrospinal fluiddrainage.

Hydrocephalus in posterior fossa lesions: ven-triculostomy and permanent shunt rates bydiagnosis. Mangubat, Erwin Zeta; Chan,Michael; Ruland, Sean; Roitberg, Ben Zion.Neurological Research, 2009 Sep, 31(7):668-73; Department of Neurosurgery, RushUniversity Medical Center, Chicago, IL.

Acute primary posterior fossa hemorrhagehas the highest rate of ventriculostomy foracute hydrocephalus and highest inpatientmortality, but a surprisingly low rate of per-manent shunt-dependency. When hydro-cephalus was caused by a neoplasm, therewas a higher rate of permanent shunt place-ment.

Infection rate with application of an antibiot-ic-impregnated catheter for shunt implan-tation in children - a retrospective analy-sis. Eymann, R; Steudel, W-I; Kiefer, M.Klinische Padiatrie, 2009 Mar-Apr,221(2):69-73; Department of Neurosurgery,Saarland University, Homburg/Saar, Germany.

An antibiotic impregnated shunt-catheter(AIS) can reduce the incidence of shunt in-fections in children.

Infection rates following initial cerebrospinalfluid shunt placement across pediatric hos-pitals in the United States. Clinical article.

Simon, Tamara D; Hall, Matthew; Riva-Cambrin,Jay; Albert, J Elaine; Jeffries, Howard E; Lafleur,Bonnie; Dean, J Michael; Kestle, John R W;Hydrocephalus Clinical Research Network. JNeurosurg Pediatr, 2009 Aug, 4(2):156-65;Divisions of Inpatient Medicine, University of Utah,Salt Lake City, UT.Infections developed in > 11% of childrenwho underwent uncomplicated initial CSFshunt placements within 24 months.Patient, hospital, and surgeon factors con-tributed somewhat to the wide variation inCSF shunt infection rates across hospitals.

Laparoscopically assisted peritoneal shunt in-sertion for hydrocephalus. Sekula, RaymondF; Marchan, Edward M; Oh, Michael Y; Kim,D Kyle; Frederickson, Andrew M; Pelz,Geoffrey; Uchal, Miro. British Journal ofNeurosurgery, 2009 Aug, 23(4):439-42;Department of Neurosurgery, AlleghenyNeuroscience Institute, Allegheny GeneralHospital, Drexel University, College of Medicine,Pittsburgh, PA.

Laparoscopic placement of peritonealshunts is safe and efficacious. It providesvisualization of the distal catheter target.Moreover, it reduces the risk of visceral com-plications, CSF pseudocysts, or extraperi-toneal placement of the catheter. In the fu-ture, laparoscopic placement of the peri-toneal portion of the catheter may becomea standard treatment in those patients re-quiring placement of a peritoneal catheter.

Laparoscopic-assisted placement of ventricu-lo-peritoneal shunt tips in children with mul-tiple previous open abdominal ventriculo-peritoneal shunt surgeries. Johnson, B W;Pimpalwar, A. European Journal of PediatricSurgery: 2009 Apr, 19(2):79-82; Departmentof Otolaryngology, Head and Neck Surgery,Childrens Hospital Missouri Healthcare,Columbia, MO.

Laparoscopic placement of the peritonealportion of a ventriculo-peritoneal shuntcan be done safely and effectively in chil-dren with multiple previous VPS revisionsdue to improved visualization and place-ment of the shunt tip in a virgin area of theabdomen. Additionally, any known or un-known complications from previous VPSsurgeries can be corrected with the laparo-scopic approach. When combined with thereduction in pain, shorter hospital stay, andfewer immediate and future complications,

this is the procedure of choice for patientsrequiring revision VPS surgeries in our hos-pital.

Management of a locked Strata valve. Bullivant,Kelly J; Mitha, Alim P; Hamilton, Mark G. JNeurosurg Pediatr, 2009 Apr, 3(4):340-3;Division of Neurosurgery, Foothills MedicalCentre and Alberta Children’s Hospital,University of Calgary, Alberta, Canada.

A known but rare complication of the Stratavalve is that the rotor can become locked,causing shunt malfunction. This compli-cation can only occur in a first generationStrata valve.

Perioperative risk factors for short term shuntrevisions in adult hydrocephalus patients.Farahmand, D; Hilmarsson, H; Högfeldt, M;Tisell, M. Journal of Neurology, Neurosurgery,and Psychiatry, 2009 Nov, 80(11):1248-53;Hydrocephalus Research Unit, Institute ofNeuroscience and Physiology, SahlgrenskaAcademy, Göteborg University, Sweden.

Right frontal placement of the ventricularcatheter was associated with the lowest rateof revisions. Adjustable valves were associ-ated with a lower risk for shunt revision.Shunt revision rates did not differ betweenventriculoperitoneal and ventriculoatrialshunts.

Postoperative cerebrospinal fluid wound leak-age as a predictor of shunt infection: aprospective analysis of 205 cases. Clinicalarticle. Jeelani, N U Owase; Kulkarni, AbhayaV; Desilva, Pani; Thompson, Dominic N P;Hayward, Richard D. Journal NeurosurgPediatr, 2009 Aug, 4(2):166-9; Departmentof Neurosurgery, Great Ormond StreetHospital, London, U.K.

The presence of a perioperative CSF leakputs pediatric patients at a very high riskof shunt infection.

Radionuclide shunt patency study for evalua-tion of suspected ventriculoperitoneal shuntmalfunction in adults with normal pressurehydrocephalus. Kharkar, Siddharth; Shuck,John; Kapoor, Sumit; Batra, Sachin; Williams,Michael A; Rigamonti, Daniele. Neurosurgery,2009 May, 64(5):909-16; Department ofNeurology, Johns Hopkins University School ofMedicine, Adult Hydrocephalus Program,Baltimore, MD.

Shunt patency studies are very useful forevaluation of shunt patency. Their resultscan be interpreted using a single-variable(T(1/2)) algorithm. Patients most likely to


SHUNT (Continued)


respond to a revision surgery are those whohad a good response to original placementof a ventriculoperitoneal shunt.

Shunt-dependent hydrocephalus after aneurys-mal subarachnoid hemorrhage: incidence,predictors, and revision rates. Clinical ar-ticle. O’Kelly, Cian J; Kulkarni, Abhaya V;Austin, Peter C; Urbach, David; Wallace, MChristopher. Journal of Neurosurgery, 2009Nov, 111(5):1029-35; Division ofNeurosurgery, Toronto Western Hospital,Ontario, Canada.

Shunt-dependent hydrocephalus affects asignificant proportion of subarachnoidhemorrhage survivors, contributing to ad-ditional morbidity among these patients.Shunt failures occur less frequently in pa-tients who underwent treatment for a rup-tured aneurysm than with other forms ofhydrocephalus. Most failures occur with-in six months, suggesting that shunt de-pendency may be transient in the majorityof patients.

The prevalence of shunt-treated hydrocephalus:a mathematical model. Stein, Sherman C;Guo, Wensheng. Surgical Neurology, 2009Aug, 72(2):131-7; Department ofNeurosurgery, University of Pennsylvania Schoolof Medicine, Philadelphia, PA.

The model gives a comprehensive view ofthe prevalence of shunt-treated hydro-cephalus in both children and adults from1955 to the present. This model may proveuseful in predicting resource use and needsfor patients with hydrocephalus.

The safety of laparoscopy in pediatric patientswith ventriculoperitoneal shunts. Fraser,Jason D; Aguayo, Pablo; Sharp, Susan W;Holcomb III, George W; Ostlie, Daniel J; StPeter, Shawn D. Journal of Laparoendoscopic& Advanced Surgical Techniques. Part A, 2009Oct, 19(5):675-8; Department of Surgery,The Children’s Mercy Hospital, Kansas City,MO.

Our data suggest that laparoscopy is safein patients with ventriculoperitonealshunts.The ventriculo-gallbladder shuntin the treatment of refractory hydro-cephalus: a review of the current literature.

The ventriculo-gallbladder shunt in the treat-ment of refractory hydrocephalus: a reviewof the current literature. Girotti, Micah E;Singh, R Ramesh; Rodgers, Bradley M. The

American Surgeon, 2009 Aug, 75(8):734-7;University of Virginia, Charlottesville, VA.

Based on durability and a low incidence ofcomplications, it is the current consensusthat VGB shunts are a viable alternativewith good outcomes in the case of failedVP shunts.

Ultrasound guidance for distal insertion ofventriculo-atrial shunt catheters: technicalnote. Sheth, Sameer A; McGirt, Matthew;Woodworth, Graeme; Wang, Paul; Rigamonti,Daniele. Neurological Research, 2009 Apr,31(3):280-2; David Geffen School of Medicineat the University of California, Los Angeles LosAngeles, CA.

The utilization of ultrasound guidance fordistal VA shunt catheter insertion may in-crease comfort with this procedure and ul-timately decrease complication rate and op-erative time.

Lumboperitoneal shunt placement using com-puted tomography and fluoroscopy in con-scious patients. Nakajima, Madoka; Bando,Kuniaki; Miyajima, Masakazu; Arai, Hajime.Journal of Neurosurgery, 2009 Sep,111(3):618-22; Department of Neurosurgery,Juntendo University, Tokyo, Japan.

This procedure is less invasive than con-ventional lumboperitoneal shunt insertionand could be performed as an outpatientsurgery for treatment of idiopathic normal-pressure hydrocephalus.

Posthemorrhagic hydrocephalus in newborns:clinical characteristics and role of ventricu-loperitoneal shunts. Lee, Inn-Chi; Lee, Hong-Shen; Su, Pen-Hua; Liao, Wen-Jui; Hu, Jui-Ming; Chen, Jia-Yun. Pediatr Neonatol, 2009Feb, 50(1):26-32; Department of Pediatrics,Chung-Shan Medical University Hospital,Taichung, Taiwan.

Patients who were shunt-dependent hadworse neurodevelopmental outcomes andgreater mortality than those withoutshunts. The results appeared to depend onhow far the hydrocephalus had progressedand on the degree of IVH, but the necessi-ty of VP shunts requires re-evaluation be-fore they are implanted.

Prediction of ventriculoperitoneal shunt de-pendency in patients with aneurysmal sub-arachnoid hemorrhage. Chan, Michael;Alaraj, Ali; Calderon, Mateo; Herrera,Sebastian Ramon; Gao, Weihua; Ruland, Sean;Roitberg, Ben Zion. Journal of Neurosurgery,

2009 Jan, 110(1):44-9; Department of Neuro -surgery, University of Illinois at Chicago, IL.

A failure risk index (FRI) score created bydiscriminant function analysis can predictwhether or not a permanent shunt is re-quired, even if separate factors are not inagreement with each other or show a weakcorrelation when considered separately. Anincreased FRI score was strongly and lin-early correlated with the risk of EVD chal-lenge failure. A prospective study is neces-sary to validate the FRI.

Shortening of ventricular shunt catheter as-sociated with cranial growth: effect of thefrontal and parieto-occipital access routeon long-term shunt patency. Nakahara,Kuniaki; Shimizu, Satoru; Utsuki, Satoshi;Suzuki, Sachio; Oka, Hidehiro; Yamada,Masaru; Kan, Shinichi; Fujii, Kiyotaka. Child’sNervous System : ChNS : official journal of theInternational Society for Pediatric Neurosurgery,2009 Jan, 25(1):91-4; Department ofNeurosurgery and Radiology, Kitasato UniversitySchool of Medicine, Kanagawa, Japan.

This study documents that insertion of theventricular catheter via the frontal route inchildren resulted in a higher incidence ofshortening due to greater displacement ofthe burr hole adjacent to the coronal su-ture. Therefore, we recommend that theparieto-occipital route be used to maintainlong-term shunt function.

Shunt implantation in a special sub-group ofpost-traumatic hydrocephalus—patientshave normal intracranial pressure withoutclinical representations of hydrocephalus.Wen, L; Wan, S; Zhan, R Y; Li, G; Gong, J B;Liu, W G; Yang, X F. Brain Injury : BI, 2009Jan, 23(1):61-4; Department of Neurosurgery,First Affiliated Hospital, College of Medicine,Zhejiang University, PR China.

Although the effect was not definitively es-tablished, many patients in the sub-groupof post-traumatic hydrocephalus (PTH) pa-tients described here would benefit fromshunt placement, especially when they si-multaneously have large cranial defects af-ter surgical decompression and underwentcranioplasties after shunt placement.Additionally, younger patients and thosewith less severe hydrocephalus before shuntplacement may expect a better outcome af-ter shunt placement.




OTHER

A contemporary definition and classificationof hydrocephalus. Rekate, Harold L. Seminarsin Pediatric Neurology, 2009 Mar, 16(1):9-15; Department of Pediatric Neurosurgery,Barrow Neurological Institute, Phoenix, AZ.

This review proposes the following defini-tion for hydrocephalus: hydrocephalus isan active distension of the ventricular sys-tem of the brain related to inadequate pas-sage of CSF from its point of productionwithin the ventricular system, to its pointof absorption into the systemic circulation.Based on this definition (potential pointsof flow restriction) and on the view of theCSF system as a hydraulic circuit, a classi-fication system is proposed. The accept-ance of this proposed definition and clas-sification schema would allow cliniciansand basic scientists to communicate effec-tively, to share information and results, andto develop testable hypotheses.

Evaluation of radionuclide cerebrospinal flu-id scintigraphy as a guide in the manage-ment of patients with hydrocephalus. Feng,Fang; Fu, Hong Liang; Li, Jia Ning; Zhou, RenJian; Gui, Zhen Hui; Wu, Jing Chuan; Wang,Hui. Clinical Imaging, 2009 Mar-Apr,33(2):85-9; Department of Nuclear Medicine,

Xin Hua Hospital, Shanghai Jiao Tong UniversitySchool of Medicine, Shanghai,China.

RCFS can definitely differentiate obstruc-tive hydrocephalus from communicatinghydrocephalus and had significance as aguide in the treatment of patients with hy-drocephalus.

Frequency of sustained intracranial pressureelevation during treatment of severe intra-ventricular hemorrhage. Ziai, Wendy C;Torbey, Michel T; Naff, Neal J; Williams,Michael A; Bullock, Ross; Marmarou, Anthony;Tuhrim, Stanley; Schmutzhard, Eric; Pfausler,Bettina; Hanley, Daniel F. CerebrovascularDiseases (Basel, Switzerland), 2009,27(4):403-10; Department of Neurology,Johns Hopkins University School of Medicine,Baltimore, MD.

In the intensive care unit, initial ICP meas-ured with an EVD was uncommonly ele-vated (1/11 patients) in this group of se-vere IVH patients despite acute obstructivehydrocephalus. Frequent monitoring re-veals ICP elevation >20 mm Hg in 14% ofobservations during use of EVD. ICP ele-vation, though it can occur, is not routine-ly associated with external ventricular drain(EVD) closure for thrombolytic treatmentwith UK.

Headaches in patients with shunts. Rekate,Harold L; Kranz, Dory. Seminars in PediatricNeurology, 2009 Mar, 16(1):27-30; BarrowNeurologic Institute, University of Arizona,College of Medicine, Phoenix, AZ.

It is likely that this population has a high-er incidence of severe headaches than nor-mal populations. The cost of managementof headaches in this population is very high,and the patients are at risk throughout life.Early treatment decisions have a significanteffect on later quality of life. Strategies thatlead to normalization of cerebrospinal flu-id dynamics, and life without shunt de-pendency are justified if they can be shownto improve later quality of life.

Intraventricular fibrinolysis and lumbardrainage for ventricular hemorrhage.Staykov, Dimitre; Huttner, Hagen B; Struffert,Tobias; Ganslandt, Oliver; Doerfler, Arnd;Schwab, Stefan; Bardutzky, Juergen. Stroke; aJournal of Cerebral Circulation, 2009 Oct,40(10):3275-80; Department of Neurology,University of Erlangen, Germany.

In patients with secondary intraventricu-lar hemorrhage and posthemorrhagic hy-drocephalus, the combined treatment ap-proach of IVF and early LD is safe and fea-sible, avoids EVD exchange, and maymarkedly reduce the need for shunt sur-gery. �



“The Mentored Young Investigator awards aremeant to encourage young investigators to pur-sue research in hydrocephalus. We have had anexcellent response to the first request for propos-als, including some investigators previously un-known in the hydrocephalus community.We arehopeful that this will stimulate young scientiststo stay involved in hydrocephalus research. Thisprogram is off to an exciting and encouragingstart.”Marion L. Walker, MD

“The Hydrocephalus Association has correctlyjudged how desperately those of us who workwith hydrocephalus and those of us who live with

hydrocephalus need some new ideas. TheMentored Young Investigator grants program hasrubbed the lamp, and new ideas have appeared.I am hugely chuffed b y the privilege of workingwith such a visionary organization.”Joe Piatt, Jr., MD

“Formost of us, one of themost important eventsin our lives relates to the identification of a rolemodel who supports and directs us to the paththat we will follow. The Hydrocephalus YoungInvestigator award is a unique opportunity to ce-ment this link between an energetic young thinkerwith an established role model and investigator.”

Harold Rekate, MD

“Great process – some surprising new ideas inthe applications. Congratulations.”

John Kestle, MD

“The Mentored Young Investigator grants fill acritical void in advancing hydrocephalus researchand attracting promising new investigators to thefield. The Hydrocephalus Association should becongratulated wholeheartedly on this effort, whichsurely will have amajor impact on promoting bet-ter treatments for this disorder.”

James P. (Pat) McAllister II, PhD�

WHAT OUR MEDICAL ADVISORY BOARD IS SAYING ABOUT THE RESEARCH INITIATIVE


By Carolyn Anderson*

Having high expectations is not aneasy path to follow when raising a

child with a disability. It requires chal-lenging yourself, your child and othersto do more than assume that a disabili-ty limits a child. But choosing the pathof high expectations is worthwhile, be-cause it improves a child’s life.Learn to challenge your expectations.

Parents have dreams and hopes for theirchildren even before they are born oradopted. When we discover, sometimesuddenly, sometimes slowly, that ourchild has a disability, our dreams andhopes may have to change. We don’t haveto expect less, but we may need to expectsomething different than what we hadimagined. As one mother said, “I don’tmake assumptions now. I am more con-scious of my hopes and dreams for all mychildren.”Parents can choose how they react to

the “world of disability.” At PACER, wesee many different parent reactions.Reactions may be affected by one’s cul-ture, family values, personality, educa-tion, economic status, learning style,health or self-esteem. But these factorsneed not define what we do. We can makechoices. We can’t control the circum-stances that affect our lives, but we cancontrol how we react to those circum-stances.For example, I was a very shy person

until I became the parent of a child withdisabilities. I decided to overcome my shy-

ness so that I could better advocate formy child. This has not been easy, as shy-ness is part of my personality. But I madea decision that speaking up on behalf ofmy child was important enough for meto make this fundamental change. Peoplewho know me now have no idea what ashy, reserved person I used to be!So why did I think I had to speak up

for my child? Like most parents, I knewnothing about my child’s disability. Oncethe disability was diagnosed, I read every-thing I could find and talked to everyonewho seemed to know anything about it.I learned that there were conflicting viewson how to deal with this disability. Onemethod of educating and rearing a childwith this disability was popular with theschool system. After considering thatmethod and my own vision for my son,I decided that it was not appropriate forhim. I would need to advocate for some-thing different, if I wanted my child toachieve the dreams I had for him.I decided to challenge myself to speak

up, rather than sit back and be quiet. Itwasn’t easy and it took a number of yearsbefore I was comfortable in my new role.But it was worthwhile. My son has donemore than I had ever envisioned.Virginia Richardson, PACER’s direc-

tor of parent training, wanted her childwith a cognitive disability to be a reader,so she expected the school to teach read-ing. There were reading goals on everyeducational plan. She read to her child,encouraged her to read at home, madesure she saw others read and gave her

books on topics that interested her. Sheframed her vision. Reading does not usu-ally just happen; this parent used strate-gies to help make it happen. Her childlearned to read newspapers for pleasureand information.While there is no guarantee that a vi-

sion will be realized, parents are respon-sible for making an effort. Every child’slife is enriched by working toward goals.Stay committed to your dreams for yourchild, work with others and keep in tunewith your child’s changing needs.Maintaining high expectations can be

difficult but worthwhile. This is whatsome parents have told us:

n “It’s been the biggest challenge of mylife and I know we’re not through. It’sbeen a challenge to be the best advo-cate I can be formy child and still keepmyself sane!”

n “I can honestly say I don’t stay up lateat night worrying about my fears any-more. Ifmy expectations have changedin anyway, they have only become big-ger, wider and more grandiose.”

n “My son is going to teach us a lotmorein life thanwewill ever be able to teachhim.” �

*CarolynAnderson is an advocate for thePACERCenter, an organization dedicat-ed to enhancing opportunities for chil-dren and young adults with disabilities.This article is excerpted from the PAC-ER booklet, “High Expectations.” Formore information, visit:www.pacer.org.

EXPECT THE BEST FOR YOUR CHILD: High expectations have rich rewards

Birmingham, ALPhoenix, AZFresno, CAOroville, CASan Francisco, CADenver, COTampa, FLChicago, ILBoston, MACambridge, MABaltimore, MDDetroit, MI

St. Louis, MOLong Branch, NJWashington Township, NJAlbuquerque, NMAlbany, NYLong Island, NYGraham, NCCleveland, OHPhiladelphia, PASan Antonio, TXSalt Lake City, UT

WALK 2009 Locations

Sarah Oxford, Regional ProgramManager

Last year marked an exceptional yearfor HA WALK. Despite the tumul-

tuous economy, our community unitedacross the nation by walking, riding andwheeling together to spread awarenessand raise funds for HA programs and re-search. Thank you for advocating for the hy-

drocephalus community.Though the growing numbers are ex-

citing and the launch of the new research

initiative motivates more communitiesto join WALK, it is important that we re-member our roots. In 1993, Evan and PipMarks led the first hydrocephalus WALKin San Francisco. With 23 family mem-bers and friends, they crossed the BayBridge, the 4.46 mile-long span thatconnects San Francisco to Oakland.TheWALK’s goal was to unite the hydro-cephalus community in San Franciscoand to raise funds for HA programs tosupport other families. It was a joyousoccasion and year after year, they have

continued to addonto their found-ing success.Sixteen years

later, following inthe footsteps ofPip and Evan,Denise Bechard,

chair of the fourth annualDetroitWALK,explainswhy she got involvedwithWALK:“When dealing with a family memberthat has a chronic condition, such as hy-drocephalus, it is easy to get over-whelmed, frustrated and to have a feel-ing of helplessness. After a long hospitalstay with Jenn [daughter], I needed to dosomething proactive to make a differencefor her, and all those that suffer withthis condition. I couldn’t just sit and al-low this condition to have the ‘last say’in our lives, nor have it control our out-look or our feelings. We needed a posi-tive focus. The WALK was a way for us totake control of our lives and this condi-tion.” Awareness and community-building

heads the list when WALK chairs discusswhy they organize the events. Long IslandWALK chair Mia Padron said, “I do this

WE CAME, WEWALKED, WEWON!


Over 5,500 people attended 24 WALKs in 18 states (AL, AZ, CA, CO, FL, IL, MA, MD, MI, OH,

NC, MO, MA, NJ, NM, NY, TX, UT) and raised over $450,000!

San Francisco, CA

Phoenix, AZ

Birmingham, ALPhotos courtesy of Kim Sharit Photography

Denver, CO

Fresno, CA

WE CAME, WE WALKED, WE WON! (continued)


for Tyler [child], tomake sure we get thatawareness out there, to get everyonebonding and forming relationships.We’renot in this alone; we’reWALKing togeth-er!” Many HA WALK chairs agreed that the

best part of organizing a WALK is unit-ing people living with hydrocephalus,who have never met someone else withthe condition. Sherry Reising and StaceyBuckner, co-chairs for the Chicago WALKexperienced that this year when a mandoing his daily exercise participated forthe first time and met other people withhydrocephalus. Many WALK chairs havehad similar experiences. As important asnational awareness is, personal aware-ness as well as a sense of belonging to acommunity are priceless. Thank you to Pip and Evan and to all

WALK chairs and participants who to-gether are making a difference.

Mia, Denise and Jennifer also sharedsome of their personal journeys as WALKchairs.“I love it, my children love it and it’s great.

We’re helping people feel not alone. If I can, I’llbe there because we’re in this together. This isour life. We’re there for each other and we haveto become like a family and that’s what I feelwith my [HA WALK] team. We’re a team anda family. It’s wonderful.” Mia Padron, Long Island, NY WALK Chair

“It was the beginning of a journey that hasprovided a sense of hope and healing for hydro-cephalus patients and their families. What start-ed as two individuals in Michigan trying to raiseawareness and funds for hydrocephalus, hasturned into hundreds coming together everyAugust to spread a message of HOPE. Togetherwe have made a difference.”Denise Bechard, Detroit, WALK Co-Chair

“I found that through my hospital stays andsurgeries, the WALK was one of the positive fac-tors that kept me motivated. Having somethingto focus on that would ultimately help otherswith hydrocephalus became my goal. Seeing thesmiles on the hydrocephalus children and adultshas been the one single vision I see repeatedlyin my head that inspires me on a daily basis.Watching a person being educated by a shuntrep and finally understanding what they havein their brain; the clowns that made childrenlaugh; the joy on a boy’s face in a wheelchairwhen all the candy from the piñata landed inhis lap; seeing a cloud of white t-shirts whilehundreds of people crossed the finish line; theseare just a few things that I replay in my headevery time I am headed back to surgery. Evenin the midst of the most trying times with hy-drocephalus, I have a reason to be thankful, be-cause I am taking part in a much bigger plan,a plan to help end the difficulties and strugglesthat come with this condition.” Jennifer Bechard, Detroit, WALK Co-Chair

Tampa, FL

Oroville, CA

Chicago, IL

Boston, MA

Albany, NY

Boca Raton, FL


Philadelphia, PA

San Antonio, TX

Cleveland, OH

Salt Lake City, UT

Baltimore, MD – courtesy of Scott Berlin Photography

Cambridge, MA St. Louis, MODetroit, MI

Graham, NCWashington Township, NJ

Long Branch, NJ

Albuquerque, NM

Long Island, NY

WE CAME, WE WALKED, WE WON! (continued)


Thara Jinadasa, Development Associate

The Campus Community Co-Coordinator program is an initiative

to raise awareness of hydrocephalusamong college students. Currently in itspilot phase, we would like to introduceour 2009-2010 CCC volunteers and high-light their achievements.

NEEL IYERHi, my name is NeelIyer. I am a thirdyear integrative bi-ology and businessadministration dou-ble major and pub-lic policy minor atUC Berkeley! I’mfrom OrangeCounty, Calif., so Ilove going to thebeach and being out in the sun. I became involved with HA as a CCC

because I believed in their mission to helpfind a cure for a condition that affects somany, but is often overlooked. I believethat there is so much we can do, especial-ly at UC Berkeley. I really want to informthe student body and get people involvedwith HA. One of my goals is to create anon-campus organization that can workwith HA to plan events and raise moneyto fight hydrocephalus. I’m excited forthe future and can’t wait to continueworking with the HA team on executingall of these ideas. Go Bears!

ANNIE SCALMANINII hail from the EastBay, so going toStanford is the per-fect distance fromhome because I stillget to see my familyat the occasionalfootball game! Myolder sister is finish-ing a master’s degreeat Stanford, and mytwin brother is at Santa Clara, which isgreat because I get to hang out with myawesome siblings pretty often. Besidesthat, I love any and everything that hasto do with music or water (I’m a totalaquatic nut — water polo, swimming, ski-ing, wakeboarding, surfing, floating, evenaqua jogging). When I first found out about the CCC

initiative, I was mostly excited by the factthat it was a new program with a lot ofroom for creativity. As I learned moreabout the position, I was drawn to theidea that it would be up to me to figureout innovative, fun ways to develop therole of the Campus CommunityCoordinator and set the tone for futureCCCs. My favorite aspect of the role is the em-

phasis on education and outreach for hy-drocephalus. My top priority is to makestudents aware of and informed abouthydrocephalus. �

CCC INITIATIVE

CCC’S FIRST STEP: TRIVIA NIGHT

Annie Scalmanini, CCC

When I was thinking of fun events tohost that would generate publicity forhydrocephalus, it occurred to me thata friend had organized a popular trivianight twice a month. Since his eventconsistently had a good turnout, I askedhim if he would partner with me for atrivia night to highlight hydrocephalus,and he agreed.We advertised the event around cam-pus and included basic informationabout hydrocephalus to help partici-pants prepare for the special trivia night(let’s be honest — all Stanford studentslove an excuse to study!). The “test run”was a huge hit; participants who hadtaken the time to read about hydro-cephalus answered the questions cor-rectly, and won HydrocephalusAssociation t-shirts!It was encouraging to see how easy itwas to spread knowledge about hydro-cephalus and how students actively par-ticipated when given the resources.

The government’s Center for DiseaseControl and Prevention (CDC) rec-

ommends vaccinations against both sea-sonal andH1N1 flu (swine flu). If you’veavoided the flu so far, don’t assume you’llbe flu-free for the rest of the season.People at higher risk for flu complica-tions include children under 5, seniorsover 65, pregnantwomen andpeoplewith

chronic health disorders. These includeneurological and neuro-developmentalconditions, asthma, diabetes and thosewith weakened immune systems. Don’tforget children under 10 require aH1N1booster, 3-4 weeks after their shot.For more information, visit the CDC’swebsite: www.cdc.gov. �

FLU SHOTS: IT’S NOT TOO LATE . . .Karima Roumila, MPH, Outreach Coordinator

Kids CornerAnswer:Oh! The Places You’ll Go!

You’ll be on your way up!You’ll be seeing great sights!You’ll join the high fliers who soarto high heights.Kid, you’ll move mountains!

Today is your day!

Your mountain is waiting.So … get on your way!

~Dr. SeussOh! The Places You’ll Go!


by Kathie Snow

Visit www.disabilityisnatural.com to seethe original, full-length article.

People with disabilities constitute ournation’s largest

minority group. It’salso the most inclu-sive: all ages, genders,religions, ethnicities,sexual orientations,and socioeconomiclevels are represented.Yet the only thing

people with disabili-ties have in common is being on the re-ceiving end of societal misunderstand-ing, prejudice, and discrimination. Andthis largest minority group is the onlyone that anyone can join, at any time: atbirth, in the split second of an accident,through illness, or during the agingprocess. If and when it happens to you,how will you want to be described?

Words matter!Old and inaccurate de-scriptors perpetuate negative stereotypesand reinforce an incredibly powerful at-titudinal barrier—the greatestobstacle facing individuals withdisabilities.A disability is, firstand foremost, a medical diag-nosis, andwhenwedefine peo-ple by their diagnoses, we de-value and disrespect them asindividuals. Do you want tobe known primarily by yourpsoriasis, gynecological his-tory, or the warts on your be-hind? Using medical diag-noses incorrectly—as ameas-ure of a person’s abilities orpotential—can ruin people’slives.

Embrace a new paradigm:“Disability is a natural partof the human experience...”(U.S. Developmental Disabil-ities/Bill of Rights Act). Yes, dis-

ability is natural, and it can be redefined asa “body part that works differently.” Aperson with spina bifida has legs thatwork differently, a person with Downsyndrome learns differently, and so forth.People can no more be defined by their

medical diagnosesthan others can bedefined by gender,ethnicity, religion,or other traits!A diagnosis

may also becomea sociopolitical pass-port for services,entitlements, or

legal protections. Thus, the only placeswhere the use of a diagnosis is relevantare medical, educational, legal, or simi-lar settings.

People First Language puts the personbefore the disability, and describes whata person has, not who a person is. Are you“cancerous” or do you have cancer? Is aperson “handicapped/disabled” or doesshe “have a disability”? Using a diagno-sis as a defining characteristic reflects

prejudice, and also robs the person of theopportunity to define himself.Let’s reframe “problems” into “needs.”

Instead of, “He has behavior problems,”we can say, “Heneeds behavior supports.”Instead of, “She has reading problems,”we can say, “She needs large print.” “Low-functioning” or “high-functioning” arepejorative and harmful. Machines “func-tion;” people live! And let’s eliminate the“special needs” descriptor—it generatespity and low expectations!A person’s self-image is tied to the

words used about him. People FirstLanguage reflects good manners, not “po-litical correctness,” and it was started byindividuals who said, “We are not our dis-abilities!” We can create a new paradigmof disability and change the world in theprocess. Using People First Language isright—just do it, now! �

Copyright 2009 Kathie Snow, All Rights Reserved. Youmay print and/or make copies of this article to use as ahandout (non-commercial use). Before using it in any oth-er way (on websites, blogs, newsletters, etc.), and to com-ply with copyright law, see the Terms of Use at www.dis-abilityisnatural.com. While you’re there, sign up for thefree Disability is Natural E-newsletter!

A FEWWORDS ABOUT PEOPLE FIRST LANGUAGE

Say:

Children/adults with disabilities.

He has a cognitive disability.

She has autism.

He has Down syndrome.

She has a learning disability.

He has a physical disability.

She uses a wheelchair.

He receives special ed services.

People without disabilities.

Communicates with her eyes/device/etc.

Congenital disability/Brain injury

Accessible parking, hotel room, etc.

Instead of:

Handicapped, disabled, special needs.

He’s mentally retarded.

She’s autistic.

He’s Down’s/mongoloid.

She’s learning disabled.

He’s a quadriplegic/crippled.

She’s confined to/wheelchair bound.

He’s in special ed; a special ed kid.

Normal or healthy people.

Is non-verbal.

Birth defect/Brain damaged

Handicapped parking, hotel room, etc.

The difference between theright word and the almostright word is the differencebetween lightning and the

lightning bug. Mark Twain

Pip Marks, HA Director of Support & Education asks you to:Say: He/She has hydrocephalusInstead of: He/She is a. . .hydrocephalic, hydro(anything), waterhead (yes, we hear these words at the office), etc.


TheHA greeting cardsfeature the work of

talented young artists af-fected by hydrocephalus.The cards are availablefor purchase and all pro-ceeds go toward a fundfor individuals and fam-ilies who need financialassistance to attendour HA Conference inCleveland from June 17-20, 2010.The 12-card set is an assortment of three unique, blank note

cards and comes with 12 white envelopes. Note card dimen-sions are 4 1⁄2 x 5 1⁄2 inches (when folded). Envelope dimensionsare 4 3⁄8 x 5 3⁄4 inches. The cards are white withmatte finish. Seethese cards in color at our website: www.hydroassoc.org.

Price: $15 (includes shipping)You may fax, e-mail, call in or mail your order. �

HA GREETING CARDSBonnie Hom, MPH, Youth& Community Coordinator

Abstract flow

Helping peopleAbout hydrocephalus

Bonnie Hom, MPH, Youth&Community Coordinator

We are very pleased to offer eightscholarships to young adults with

hydrocephalus. The scholarships are $500each and will be awarded in June. If youwould like to apply, please e-mail Bonnieat [email protected], or call ouroffice: 888-598-3789. Depending on yourpreference, wewillmail or e-mail you theapplication with instructions.

ELIGIBILITY REQUIREMENTS:n Applicants must be 17 or older andhave hydrocephalus.

n Scholarship fundsmust be used for ed-ucational purposes, such as during afour-year or junior college, a highschool postgraduate year to prepare forcollege, a technical or trade school, anaccredited employment-training pro-gram or a postgraduate program.

n The scholarship may be used for tu-ition, books, housing or expenses di-rectly related to education.

n The deadline for completed applica-tions and recommendation forms isApril 1. Applications received after this

date, or incomplete applications willnot be considered

SCHOLARSHIPS OFFERED:GERARD SWARTZ FUDGEMEMORIALSCHOLARSHIPThis fundwas established in 1994 by theFudge family. Their son, Gerard, had hy-drocephalus and a brain tumor. He diedin 1992 at the age of 22, during his timeat college. This scholarship honors hiszest for life and his kind and gentle spir-it. Two scholarships are awarded eachyear from this fund.

MORRIS L. AND REBECCA ZISKINDMEMORIAL SCHOLARSHIPThis fund was established in 2001 byRebecca Ziskind and her family inmem-ory of her husband, Dr. Morris Ziskind,whohadnormal pressure hydrocephalus.After Rebecca Ziskind’s death in 2005,their three surviving children and theirspouses—Carrie andDeeNorton, Jeromeand Rosemary Ziskind, and Janet andCharles Tarino—graciously funded onemore scholarship in loving memory oftheir parents. Two scholarships are nowawarded from this fund.

ANTHONY ABBENE SCHOLARSHIPThis fund was established in 2002 byAnthony Abbene’s extended family.Anthony is a teenager with hydro-cephalus. This fund awards two scholar-ships in honor of Anthony to help oth-ers with hydrocephalus with their edu-cation.

JUSTIN SCOT ALSTONMEMORIALSCHOLARSHIPGloria M. Alston established this schol-arship in lovingmemory of her son, JustinScot Alston, who died in 2004. Justin re-ceived a Hydrocephalus Associationscholarship in 2002 and will be remem-bered for his tremendous upbeat attitudeand for all that he accomplished duringhis short life.

MARIO J. TOCCO HYDROCEPHALUSFOUNDATION SCHOLARSHIPThis scholarship was endowed in 2007by Greg Tocco, executive director of theHydrocephalus Foundation, Inc., ofSaugus, Mass., and his family in honorandmemory ofGreg’s grandfather,MarioJ. Tocco. �

SCHOLARSHIPS AVAILABLE

News Notes22 n Pathways WINTER 2010

SPINA BIFIDA GENETICS RESEARCH PROJECTThe Spina Bifida Association is urgingmothers of children with the conditionto enroll in a research program. TheSpinaBifidaGeneticsResearchProjectis studying variations in genes involvedwith folic acid metabolism. If the studyresults are positive, it may be possible todevelop a test to identify women at riskof having a baby with spina bifida, whocan be treated with high dose folic acidbefore conception.More than 800 participants from the

U.S. and abroad have already enrolled.In an effort tomeet the study’s objectives,

the SpinaBifidaGeneticsResearchProjectis trying to increase awareness at clinicsthat treat patients with the condition.Study participants complete an onlineenrollment survey and are sent at-homesaliva collection kits.Contact the Spina Bifida Genetics

Research Project by e-mail [email protected], or by phoneat 650-212-0822. For additionalinformation, go to the study website:www.sbgenetics.org. Your help willmake a big difference.

LEARN MORE ABOUT LEARNING DISABILITIES

The State of Learning Disabilities 2009is a report on the status of children, ado-lescents and adults with learning disabil-ities (LD). Written by the National Centerfor Learning Disabilities (NCLD), the re-port challenges common myths aboutLD and provides benchmark data to com-pare and contrast how people with LDare faring in school and work.

NCLD offers this publication to poli-cy makers, education professionals, me-dia, parents and others to share key LDdata and expand awareness about whatLD is and whom the condition impacts.To download a copy of this report, go

to: http://www.ncld.org/stateofld

RARE DISEASE DAYRAISES AWARENESS

Rare Disease Day is a global initiative thateducates and raises awareness about rarediseases as a public health concern. TheHydrocephalus Association has added itssupport to this cause. Nearly 1 in 10 Americans and millions

of others around the world have rare dis-eases. Many of these people have no treat-ment or inadequate medical care and serv-ices. Stories about real people who haverare diseases are an important education-al tool. To help people across the nation un-

derstand what it’s like to have a rare dis-ease, the National Organization for RareDisorders (NORD) will be collecting pa-tient stories for possible future publica-tion.For more information about NORD

and rare disease day, visit: www.rarediseaseday.us

Igpay Atinlay – Pig Latin

As a tribute to all kids and kids-at-heart, this edi-tion of Kid’s Corner features a poem by a very spe-cial author. You may recognize the poem, afteryou’ve deciphered the Pig Latin, of course. In thespirit of the New Year, we, the staff at theHydrocephalus Association, wish you success andjoy in the many accomplishments you’ll achievethis year and beyond.

To translate from Pig Latin to English, removethe –ay in every word and move the last letter tothe beginning. For example: “ello-hay” is “hello”and “ey-they” is “they.”

Ohyay! eThay acesPlay Youyay’llay oGay!

Youyay’llay ebay onyay youryay ayway upyay! Youyay’llay ebay eeingsay eatgray ightssay! Youyay’llay oinjay ethay ighhay iersflay owhay

oarsay otay ighhay eightshay. idKay, youyay’llay ovemay ountainsmay!

odayTay isyay youryay ayday! Youryay ountainmay isyay aitingway. oSay … etgay onyay youryay ayway!

~Dray. eussSay Ohyay! eThay acesPlay Youyay’llay oGay!

Kid’s Corner!Bonnie Hom, MPH, Youth& Community Coordinator

Hydrocephalus AssociationWINTER 2010 MEMBERSHIP FORM □ RENEWAL □ NEW

Please return this form with check, money order or completed credit card information to:Hydrocephalus Association � 870 Market Street � Suite 705 � San Francisco, CA 94102

Tel. 415-732-7040 � Toll Free 888-598-3789 � Fax 415-732-7044 � Email: [email protected]

□ Count me in as a member for 2010. Enclosed is my unrestricted donation of:

□ $30 □ $50 □ $100 □ Other $____________

How would you like to receive your quarterly newsletter?Opt to receive your newsletter via email — this will allow the Association to put a portion of the $30,000 annual printing and postage coststo other programs.

□ Please send my newsletter via email to: _______________________________________________________________

□ I still prefer to receive a printed copy of the newsletter via the US mail.

Charge my: □VISA □ MasterCard □ Discover Amount Charged $ ______________

Card No. ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ Exp. Date __ __ / __ __ VIN #_____

Print Name _____________________________________________________

Signature_______________________________________________________

□ Please remove my name from your mailing list.

□ I cannot afford a donation at this time but I would like to be counted as a member.

Please check all that apply:□ I am on SSI or Disability. □ My medical bills have exhausted my finances. □ My income is below $30,000 per year.

Name: __________________________________________________________ Telephone: _______________________________

Address: ________________________________________________________

________________________________________________________________ Email: _______________________________

Name of person with hydrocephalus: ______________________________________________ Birth date: __________ Age at diagnosis: _____

His/her relationship to you: □ self □ child □parent □ spouse □ friend/other relative □N/A (professional member)

The Hydrocephalus Association is a national nonprofit organization whosemission is to eliminate the challenges of hydrocephalus by stimulating in-novative research and providing support, education and advocacy for indi-viduals, families and professionals dealing with hydrocephalus. Pathways ispublished quarterly. Thomas G. Smith is the editor. Articles included in thePathways are for the reader’s information and do not signify endorsementby the Association. We welcome letters and articles from our readers but re-serve the right to edit any material submitted for publication. Informationand articles from the Pathways may be reprinted provided a full citation ofsource is given.© 2010 Hydrocephalus Association

CHIEF EXECUTIVE OFFICER: Laurene McKillopACTING CHIEF EXECUTIVE OFFICER: Rick SmithOPERATIONS MANAGER: Jerry AcostaINTERIM DEVELOPMENT DIRECTOR: Anne HolmesYOUTH & COMMUNITY COORDINATOR: Bonnie Hom, MPHDEVELOPMENT ASSOCIATE: Thara JinadasaDIRECTOR OF SUPPORT & EDUCATION: Pip MarksREGIONAL PROGRAMMANAGER: Sarah OxfordOUTREACH COORDINATOR: Karima Roumila, MPHRESEARCH ASSOCIATE: Donna ShafferOUTREACH & MEDIA LIAISON: Thomas G. Smith

MEDICAL ADVISORY BOARDRick Abbott, MD n Marvin Bergsneider, MD n James M. Drake, MD n MichaelEgnor, MD nRichard G. Ellenbogen, MD nAnn Marie Flannery, MD n Bruce A.Kaufman, MD n John R. Kestle, MD nMark Luciano, MD n Joseph R. Madsen, MDn James P. (Pat) McAllister II, PhD n J. Gordon McComb, MD n C. ScottMcLanahan, MD nDavid G. McLone, MD, PhD n Joseph H. Piatt, Jr., MD nHaroldL. Rekate, MD nMarion L. Walker, MD nMichael A. Williams, MD n Jeffrey H.Wisoff, MD nMichael Edwards, MD, Emeritus

Hydrocephalus Associationserving individuals, families and professionals since 1983

870 Market Street #705 • San Francisco, California 94102Telephone (415) 732-7040 • Fax (415) 732-7044 • Toll-Free (888) 598-3789

Website: www.hydroassoc.org • Email: [email protected]

HYDROCEPHALUS ASSOCIATION RESOURCES AND FACT SHEETS

The following resources are available free to our members:About Hydrocephalus—A Book for Families (in English or Spanish)

About Normal Pressure Hydrocephalus (Adult-Onset)

Prenatal Hydrocephalus—A Book for Parents

Hydrocephalus Diagnosed in Young to Middle-Aged Adults

A Teacher’s Guide to Hydrocephalus

Health-Care Transition Guide for Teens and Young Adults

Directory of Pediatric Neurosurgeons

Directory of Neurosurgeons for Adults

Directory of Congenital Neurosurgeons for Adults

Directory of Neuropsychologists

Fact SheetsPrimary Care Needs of Children with Hydrocephalus

Learning Disabilities in Children with Hydrocephalus

Hospitalization Tips

Headaches and Hydrocephalus

Social Skills Development in Children with Hydrocephalus

Eye Problems Associated with Hydrocephalus

Survival Skills for the Family Unit

Durable Power of Attorney for Health Care Decisions

Endoscopic Third Ventriculostomy

Cerebrospinal Fluid Shunt Systems for Management of Hydrocephalus

Nonverbal Learning Disorder Syndrome

How to Be an Assertive Member of the Treatment Team

Second Opinions

College & Hydrocephalus

Financial Aid and Scholarships

Understanding Your Child’s Education Needs/IEP Resource Packets

870 Market StreetSuite 705San Francisco, CA 94102

Non-profit OrganizationU.S. POSTAGE

PAIDSan Francisco, California

PERMIT NO. 307

pathways winter 2010 - hydrocephalus association · 2016. 9. 13. · singh, kuldev. journal of...

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