Hydrocephalus, otherwise known as water on the brain, is a condition where cerebrospinal fluid (CSF) accumulates within the brain. Hydrocephalus that occurs in childhood has a frequency of about 1 person in 1100 within the USA. The surgical placement of a shunt system is the usual treatment. Unfortunately, up to 85% of pediatric CSF shunt systems fail within 10 years, furthermore 40% fail within 2 years. Solutions are clearly needed.
Failure of the shunt is usually due to tissue obstruction, making it a biological problem, rather than a mechanical malfunction. Studying the biology of the obstructions could reveal solutions to prevent their formation. In order to make useful generalized solutions that could prevent shunt malfunctions for most people a large collection or biobank of failed shunts is needed for research.
Carolyn A. Harris of Wayne State University, Detroit, USA, and colleagues, created a national biobank of all failed shunt hardware. In a report published in the journal Fluids and Barriers of the CNS the authors detail the biobank and demonstrate how participating centers can benchmark their performance against others.
The biobank currently contains 293 samples obtained from 228 pediatric hydrocephalus patients. The shunt samples were stored in a solution of paraformaldehyde (PFA) following surgery. Where available CSF was processed and cryopreserved.
The clinical data of the participants was also collected and logged using the REDCap electronic data capture tools hosted at Wayne State University.
Of interest, the median length of time before a shunt in the biobank failed was less than a year, in most of the collection locations closer to half a year, highlighting the current poor performance of these devices.
The biobank has already provided clues for improvement, indicating that post-hemorrhagic, myelomeningocele, aqueductal stenosis, Dandy-Walker malformation, congenital CNS malformations, unknown, and other factors as being positively correlated with shunt obstruction.
Analysis of the biobank is potentially limited by shunt preservation in PFA. Previous biobank studies have indicated that cryopreservation is superior to PFA storage for genomic characterization, so the shunt samples may be better suited to other forms of analysis such as microscopy and cytometry.
“We have created a biobank for samples from failed shunt systems in pediatric patients with hydrocephalus for which there is a corresponding database with clinical variables. Currently 6 centers are participating,” stated the authors.