Loyola Neurosurgeon Addresses Hydrocephalus | News | Loyola Medicine

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Tuesday, January 12, 2016

Vikram Prabhu, MD, issues hydrocephalus challenge in World Neurosurgery editorial

Hydrocephalus block letters and stethoscope.

MAYWOOD, Ill. – Every year, thousands of babies worldwide die from untreated hydrocephalus, a condition in which the head swells from a buildup of excess fluid. But no baby need die from this condition, once called “water on the brain.” Neurosurgeons now have the skills and tools to deal with the condition very effectively.

In an editorial in December 2015 issue of the journal World Neurosurgery, Loyola University Medical Center neurosurgeon Vikram Prabhu, MD, examines the issue of hydrocephalus in Uganda. Dr. Prabhu is a professor in the Department of Neurological Surgery of Loyola University Chicago Stritch School of Medicine.

Hydrocephalus is the excess accumulation of cerebrospinal fluid, which circulates throughout the brain and spinal column and can cause significant damage and even death. It mostly affects children, although adults also can get hydrocephalus. It is very treatable with surgery.

Conventional treatment involves running a shunt (a thin tube) from the brain to the abdomen and using a valve to regulate fluid draining from the brain. Excess cerebrospinal fluid is diverted to the abdominal cavity, where it is easily absorbed. But shunts are expensive and complex systems that require frequent checks and may be prone to failure. The system is difficult even in developed countries. In developing countries, which lack the infrastructure to deal with inevitable infections and malfunctions, it is practically impossible to safely monitor and care for these devices.

Neurosurgeon Benjamin Warf, MD, developed a one-time, minimally-invasive endoscopic procedure that is safe, effective and easy to implement. (The technical term for the Warf procedure is endoscopic third ventriculostomy with choroid plexus and cauterization.) Dr. Warf established a center in Uganda that has provided neurosurgical care to scores of children with hydrocephalus, saving many lives.

“This is one of the best paradigms of global neurosurgery, and there are lessons to be learned,” Dr. Prabhu wrote. “The most important may be its lack of complexity; in other words, simplicity is the most powerful tool.”

Healthcare in the developing world often is dictated by cost. The Warf procedure is an example of how sparse resources “have spurred innovative physicians to pioneer efforts that provide health care in a parsimonious manner …” Dr. Prabhu wrote. “We have much to learn from them, and their innovations may fuel cost-effective strategies back home.”

Major medical facilities are required to successfully implement complex systems that are prone to break down or not be properly implemented or updated. Simple solutions such as the Warf procedure can benefit areas of the world that lack such facilities, Dr. Prabhu wrote.

Dr. Prabhu challenged neurosurgeons to carry on the intrepid work of Dr. Warf, who won a MacArthur Foundation “genius grant” and now is at Harvard Medical School.

“We should set a realistic goal with a finite timeline and pour our resources into it,” Dr. Prabhu wrote. Unlike chronic illnesses that can be managed with medications but not eliminated or cured, hydrocephalus can be controlled very effectively by a surgical procedure that all neurosurgeons are familiar with and adept at.

Dr. Prabhu noted that the Lancet Commission on Global Surgery estimated that 5,000 surgeries for every 100,000 people would be sufficient to cover basic surgical needs – a worthwhile goal for surgeons worldwide.

Dr. Prabhu proposed that neurosurgeons set a similar but more precise goal for themselves: “No child should die of untreated hydrocephalus anywhere on this planet by 2030.”

Read Dr. Prahbh’s editorial in World Neurosurgery.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.