Alberta Health Services says a new neurosurgery is saving lives in Calgary.
Performed by Dr. Jay Riva-Cambrin at the Alberta Children’s Hospital, the surgery is minimally invasive and alleviates the build-up in fluid caused by hydrocephalus.
Hydrocephalus, or “water in the brain,” is when there is an excess of cerebrospinal fluid (CSF). Although this fluid is crucial to brain function, an excess could lead to an untimely death. When there is an excess of CSF, it enlarges the spaces in the brain, or ventricles, causing a visible change – an enlarged head. Other symptoms include vomiting and irritability, and can cause slow growth and decreased mental function.
About 50 to 60 babies in Alberta are treated for hydrocephalus each year, with over half of the cases in Calgary. According to Dr. Cambrin, between one in 500 and one in 2,000 babies are born with hydrocephalus, while another 600 acquire it at birth.
In addition to a clinical exam, diagnosis of hydrocephalus requires patient history to be compatible with raised cranial pressure and an MRI.
The options for treatment are limited, and currently most are treated by having an internal shunt put in to connect the brain to the abdominal cavity to drain the fluid. This solution is less than ideal, with most patients having to undergo repeat surgeries to replace the shunt, which is commonly gets infected.
Riva-Cambrin said someone who receives a shunt could require between two and 30 additional surgeries for maintenance and replacing of the shunt.
The new surgery is done for infants under 24 months, by creating a small hole in the skull and using a camera to guide the surgeon’s tools in, creating a bypass for the cerebrospinal fluid that has built up in the brain. The surgeon then disables some of the tissue that produces the CSF. This surgery is called endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC).
The most recent surgery was performed on Baya Plessis, who developed hydrocephalus after contracting a brain infection at birth. After a two-hour surgery, Baya’s parents are relieved that she will not be left with a permanent shunt.
After conducting seven successful surgeries thus far, Riva-Cambrin is currently training doctors in Edmonton to perform the surgery. If Baya had not undergone the surgery, she could have been left with a blood clot in her brain and scar tissue that could have furthered the issue.
There are multiple ongoing studies within the Hydrocephalus Clinical Research Network to study risk factors, to determine the best candidates for the procedure, and to compare the results with children who have shunts.
The surgery was developed by Dr. Benjamin Warf to treat children in Africa with hydrocephalus, as the medical infrastructure there could not support repeat surgeries to maintain shunts. He then moved to the Boston Children’s Hospital, and brought the surgery to the United States.
Riva-Cambrin has performed the surgery about 70 times in Salt Lake City, prior to relocating to Calgary. The surgery is also being performed in Toronto by Dr. Abhaya Kulkarni at the Hospital for Sick Children/University of Toronto.