CSF Research Projects
Patients who undergo clinically-indicated procedures and tests can consent to participate in research studies that aim to understand CSF-related neurological disease such as adult hydrocephalus or idiopathic intracranial hypertension. You can find descriptions of our projects below.
1
Epidemiology and Health Care Costs of Hydrocephalus using HCUP databases
Hydrocephalus is a poorly understood neurologic condition with a bi-modal distribution and varied manifestations across the lifespan. There are limited neurosurgical treatments and a wide distribution in terms of outcomes. In adults, it remains underdiagnosed. The estimated prevalence of Normal Pressure Hydrocephalus is about 700,000 in the United States. Using data from the H-CUP databases – the Nationwide Inpatient Sample and Kids Inpatient Database (https://www.hcup-us.ahrq.gov/databases.jsp) our aim is to understand the epidemiology and drivers of health care costs for this condition in addition to understanding racial and socio-economic barriers to care for this underserved population. This work is being done in close collaboration with the Hydrocephalus Association (https://www.hydroassoc.org/) which supports and advocates for research into this condition.
2
Role of comorbidities and frailty in Normal Pressure Hydrocephalus (NPH) management
While NPH can be treated with shunt surgery, and short-term outcomes (up to 1 year) are excellent, the long-term outcomes vary quite considerably on an individual basis. While our research has identified CSF biomarkers that can predict the long-term outcome, this is not translatable to sites that lack the expertise in measuring biofluid neurodegenerative biomarkers. The goal of this project is to assess easily accessible non-invasive tests that quantify comorbidity and frailty in patients with NPH and determine if they can predict long-term outcomes in patients with NPH.
3
Retrospective Study of Shunt vs. Stent outcomes in Idiopathic Intracranial Hypertension (IIH)
There are currently two neurosurgical interventions for the treatment of IIH in patients at risk for visual loss or those who have failed maximal medical management. Shunts have been around for 50 years but have significant morbidity and even mortality associated with them. In contrast, stenting is a relatively new approach for treatment for IIH but not everyone is a good candidate for stenting and in some individuals stenting does not work beyond a few months. This study aims to determine the real world effectiveness of shunt vs stent implantation and identify patient characteristics that could predict response to one treatment modality vs the other.
4
Blood vs. CSF biomarkers of Normal Pressure Hydrocephalus (NPH)
Our earlier work identified a combination of cerebrospinal fluid neurodegenerative biomarkers that at baseline can predict which patients with shunts can expect to have a sustained improvement after shunt surgery. However, access to CSF can be limited as it is invasive as compared to the collection of blood from a peripheral vein. The goal of this project is to determine if we can predict long-term improvement using brain-derived neurodegeneration biomarkers measured in blood using sensitive single-molecule assays.
5
Role of adipokines and sex-related steroid hormones in Idiopathic Intracranial Hypertension (IIH)
IIH is a condition that results from elevated intracranial pressure that can cause debilitating headaches and in extreme cases lead to permanent visual loss. This condition affects women nine times more often than men. The underlying biologic basis of this susceptibility is poorly understood. In addition, obesity is the single most important risk factor for this condition. Given the increasing prevalence of obesity, what mediates this risk is important to understand at a biological level. The goal of this project is to understand the role of sex-related steroid hormones and adipokines in the development of IIH.