title: An update on research priorities in hydrocephalus: overview of the third National Institutes of Health-sponsored symposium "Opportunities for Hydrocephalus Research: Pathways to Better Outcomes".
abstract: Building on previous National Institutes of Health-sponsored symposia on hydrocephalus research, "Opportunities for Hydrocephalus Research: Pathways to Better Outcomes" was held in Seattle, Washington, July 9-11, 2012. Plenary sessions were organized into four major themes, each with two subtopics: Causes of Hydrocephalus (Genetics and Pathophysiological Modifications); Diagnosis of Hydrocephalus (Biomarkers and Neuroimaging); Treatment of Hydrocephalus (Bioengineering Advances and Surgical Treatments); and Outcome in Hydrocephalus (Neuropsychological and Neurological). International experts gave plenary talks, and extensive group discussions were held for each of the major themes. The conference emphasized patient-centered care and translational research, with the main objective to arrive at a consensus on priorities in hydrocephalus that have the potential to impact patient care in the next 5 years. The current state of hydrocephalus research and treatment was presented, and the following priorities for research were recommended for each theme. 1) Causes of Hydrocephalus-CSF absorption, production, and related drug therapies; pathogenesis of human hydrocephalus; improved animal and in vitro models of hydrocephalus; developmental and macromolecular transport mechanisms; biomechanical changes in hydrocephalus; and age-dependent mechanisms in the development of hydrocephalus. 2) Diagnosis of Hydrocephalus-implementation of a standardized set of protocols and a shared repository of technical information; prospective studies of multimodal techniques including MRI and CSF biomarkers to test potential pharmacological treatments; and quantitative and cost-effective CSF assessment techniques. 3) Treatment of Hydrocephalus-improved bioengineering efforts to reduce proximal catheter and overall shunt failure; external or implantable diagnostics and support for the biological infrastructure research that informs these efforts; and evidence-based surgical standardization with longitudinal metrics to validate or refute implemented practices, procedures, or tests. 4) Outcome in Hydrocephalus-development of specific, reliable batteries with metrics focused on the hydrocephalic patient; measurements of neurocognitive outcome and quality-of-life measures that are adaptable, trackable across the growth spectrum, and applicable cross-culturally; development of comparison metrics against normal aging and sensitive screening tools to diagnose idiopathic normal pressure hydrocephalus against appropriate normative age-based data; better understanding of the incidence and prevalence of hydrocephalus within both pediatric and adult populations; and comparisons of aging patterns in adults with hydrocephalus against normal aging patterns.
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri;
authors.forename: James P
authors.initials: JP
authors.lastname: McAllister
authors.affiliation: Department of Neurology, The Sandra and Malcolm Berman Brain & Spine Institute and Adult Hydrocephalus Center, Sinai Hospital, Baltimore, Maryland;
authors.forename: Michael A
authors.initials: MA
authors.lastname: Williams
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Medical Center, Salt Lake City, Utah;
authors.forename: Marion L
authors.initials: ML
authors.lastname: Walker
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Medical Center, Salt Lake City, Utah;
authors.forename: John R W
authors.initials: JR
authors.lastname: Kestle
authors.affiliation: Department of Neurology, Weill Cornell Medical College, New York, New York;
authors.forename: Norman R
authors.initials: NR
authors.lastname: Relkin
authors.affiliation: Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Anderson
authors.affiliation: Hydrocephalus Association, Bethesda, Maryland.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Gross
authors.affiliation: Departments of Neurosurgery and Bioengineering, University of Washington and Seattle Children's Hospital, Seattle, Washington;
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Browd
mesh_terms: D006292:Health Priorities; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care; D057170:Translational Research, Biomedical; D014481:United States
keywords: CPC = choroid plexus cauterization; DTI = diffusion tensor imaging; ETV = endoscopic third ventriculostomy; HCRN = Hydrocephalus Clinical Research Network; ICP = intracranial pressure; LPA = lysophosphatidic acid; NIH = National Institutes of Health; NPC = neural precursor cell; NPH = normal pressure hydrocephalus; NSC = neural stem cell; National Institutes of Health; PreOL = precursor oligodendroglia; RCT = randomized controlled trial; SVZ = subventricular zone; TNF = tumor necrosis factor; VP = ventriculoperitoneal; VZ = ventricular zone; conference; hydrocephalus; iNPH = idiopathic NPH; research; symposium