HYDROCEPHALUS
RESEARCH GROUP
ABOUT THE RESEARCH GROUP
The Hydrocephalus Research Group is an ongoing project conducted in cooperation between the Departments of Neurosurgery at Cairo University, Egypt, and Greifswald Medical School of the University of Greifswald, Germany. Under supervision of the neurosurgical faculty at both institutions, the research group realises both high-standard clinical and secondary research projects in the neurosurgical field of Hydrocephalus. The disease has lent its name from the Greek language whereby ‘hydro’ implies ‘water’ and ‘cephalus’ refers to the ‘head’. The current commendatory approach to treatment by surgically inserting a shunt system displaces the water from the brain rather than it removes the water from the body. Surgeries are therefore a temporal solution rather than a durable cure. The incurability of the disease poses a great challenge to the neurosurgical field and calls for innovative research and interventional procedures. Under the umbrella of this ongoing project, The Hydrocephalus Research Group has taken up this call.
RESEARCH FOUNDATION WITH A MISSION
Amid a lack of legible statistical data, a high rate of illegible patients in Egypt and Sub-Saharan Africa suffer the hydrocephalus critical medical condition. Invested in ensuring a better quality of life, health care has high stakes in pooling scientific resources to produce high-quality research to further the development of the field of Hydrocephalus. In order to address this pressing issue and to illuminate the disease, The Hydrocephalus Research Group was launched to both raise awareness by increasing visibility and conduct quality research to secure a better quality of life for hydrocephalus patients.
OUR ACTIVITIES
In the scope of the research group’s mission, the research activities tackle epidemiology, surgical management, and perioperative care of pediatric hydrocephalus. Most of the projects entail clinical research in addition to secondary research being conducted in the form of evidence-based medicine and systematic reviews.
The three main research threads involve the Choroid Plexus Coagulation (CPC) surgical treatment of hydrocephalus, the shunt placement surgery by laparoscopic ventriculoperitoneal shunt insertion, and the excessive build-up of fluid in the brain called ventriculitis.
The Hydrocephalus Research Group has access to the Abul Reesh Children’s Hospital at Cairo University as a vibrant research site. The Cairo’s University’s Abul Reesh Children’s Hospital is seeing a great influx of Hydrocephalus cases. The hospital is representative of how the healthcare infrastructure is unable to cope with the increasing demand of hydrocephalus patient care needs. The research group shines a light on this topical issue in Egypt by one of its activities of compiling a waiting list for surgeries.
Being a tertiary care referral centre for cases from all over Egypt and for some neighbouring countries in the region, the research site further enables research conduction on a large patient group, diagnosed with hydrocephalus.
Publications in prestigious neurosurgical academic journals with a high impact factor are illustrative of the successful scientific output of the Hydrocephalus Research Group.
Besides research practice, the Hydrocephalus Research Group has also an eye for research training. With the mission to democratise medical research practice and the vision to melt the ice between junior and senior neurosurgeons, the Hydrocephalus Research Group successfully launched the education program: Basic Research Training in Neuroscience for Undergraduates.
CHOROID PLEXUS COAGULATION (CPC)
Specialised in the field of Neuroendoscopy, the Hydrocephalus Research Group conducts research on the endoscopic surgical Choroid Plexus Coagulation (CPC) treatment of hydrocephalus. Commonly visualised as the disease of ‘water on the brain’, the swelling and inflammation of the brain in medical terms results from the build-up of Cerebrospinal fluid (CSF). Like oil to the engine, the right amount of fluid helps the brain’s nervous system to run smoothly. Like a filter to waste products, the liquid is responsible for removing waste impurities from the brain. Like airbags in cars, the clear and colourless liquid acts like a protective cushion to your brain against a sudden impact or injury. By the words of the 17th-century scientist Emanual Swedenborg, CSF entered the history books as the “highly gifted juice” and the key source of this liquid is the Choroid Plexus. However, the overproduction of CSF by the Choroid Plexus is too much of a good thing. Therefore, the CPC surgical procedure ablates the choroid plexus tissue to decrease both the production of the CSF liquid and may also reduce the pulses causing the enlargement of the brain. This procedure is done by coagulation, allowing the blood flow to clot. Hydrocephalus is caused by either an overproduction, a blockage of the CSF flow, or the failure of the bloodstream to absorb the liquid. The choroid plexus is therefore a gatekeeper to the cure of hydrocephalus disease. Further research engagement in CPC surgical treatment is therefore a core task of the Hydrocephalus Research Group.
LAPAROSCOPIC VENTRICULOPERITONEAL SHUNT INSERTION
Like rain goes down the drain, drainage of excessive cerebrospinal fluid (CSF) -‘water on the brain’- is a common technique to treat hydrocephalus. Thinking of the sewerage pipelines conveying sewage water from its point of origin to a point of treatment and disposal, the preferred route of treatment of 'water on the brain’ is towards the peritoneal cavity; or 'the belly’ for the man in the street. The belly acts like a basin that more easily absorbs the excessive CSF fluid. By the surgical procedure of laparoscopy going through the abdominal wall, access to the potential space of disposal around the belly is facilitated in order to insert ventriculoperitoneal (VP) shunts; a medical drain. With beneficial outcomes regarding patient safety, the Hydrocephalus Research Group focuses on raising awareness of this procedure through knowledge production and surgical education. While often the procedure remains in the hands of high-specialised senior neurosurgeons, the Hydrocephalus Research Group emphasises the importance of democratising this practice in the neurosurgical field through research and education.
VENTRICULITIS
While the brain is bathing in cerebrospinal fluid (CSF), the fluid glides through brain ventricles like waterslides. Offering the transportation of the fluid and being home to the source of the fluid, namely choroid plexuses, the brain ventricles regulate a cycle of constant production and reabsorption, a stream of ebb and flow. If, however, the circulation of the fluid suffers from malfunctioning, our brain becomes diagnosed with ventriculitis. Ventriculitis points to the inflammation and enlargement of the ventricles, which eventually can lead to hydrocephalus. If not diagnosed in the early stage, treating the inflammation of the ventricles poses a great challenge to the neurosurgical field. Currently, the prospect of a curable treatment is still in its infancy. All the while the patient suffers severe effects of the disease, undergoes a continuum of treatments, and faces hospitalisation. Research on ventriculitis is therefore a pressing issue for treating hydrocephalus specifically and for the neurosurgical field in general. The Hydrocephalus Research Group responds to this call for further examination of the disease.
MONTHLY WAITING LIST SURGERIES
Besides research activities, the Hydrocephalus Research Group proceeds in its mission to visualise the high rate of patients, often unnoticed due to a lack of legible data. While the incurability of the disease itself is one main aspect that urges further research, the implementation of the available treatments, suffering several impediments, is another main factor to be counted in. Providing the necessary quality of health care not only asks for scientific solutions but also demands a social response. To raise awareness regarding the latter, the Hydrocephalus Research Group compiled a waiting list for surgeries as an active prompt to visualise the disease as a source of conflict in society and stands as a call for investing in the workforce and infrastructural needs.