Thrasher Research Fund - Medical research grants to improve the lives of children

Project Details

Early Career

Status: Funded - Open

Optical neuromonitoring for early indication of surgical efficacy in infantile hydrocephalus

Ajay Rajaram, PhD


BACKGROUND: The United States treats 39,000 infants with newly presenting hydrocephalus annually, while over 100,000 new cases present in Sub-Saharan Africa each year. Surgical treatment using endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV/CPC) has advantages over traditional shunting methods (i.e. less post-operative care, lower rates of infection) but has demonstrated similar rates of failure (25-35% within 14 months) [Kulkarni et al., N Engl J Med, 2017]. GAP: Current imaging techniques (MRI, CT, ultrasound) are essential to diagnosing hydrocephalus, but are insensitive as an early indication of surgical efficacy as they primarily focus on anatomical changes. Biomedical optics can provide non-invasive bedside longitudinal monitoring to capture changes in cerebral physiology in response to treatment and has potential to assess early surgical outcome. HYPOTHESIS: This study seeks to compare the utility of optical neuromonitoring and volumetric brain imaging for the timely assessment of surgical treatment efficacy. We hypothesize that perioperative increases in cerebral blood flow and metabolism measured optically will indicate successful surgery (with a decrease or absence of change indicating treatment failure) and provide earlier outcome prediction than brain imaging techniques. METHODS: Hydrocephalic infants scheduled for ETV/CPC or shunt insertion at Boston Children’s Hospital (BCH) and CURE Children’s Hospital of Uganda (CCHU) will be optically monitored and imaged (MRI at BCH; CT and ultrasound at CCHU) one day pre- and post-operatively, and at one-, three-, and six-months post-op. Cerebral blood flow and metabolism, as measured by optics, and brain tissue and ventricle volumes, acquired through imaging, will be assessed against surgical outcome. RESULTS: Subject enrollment at BCH and CCHU is ongoing [Vadset et al., Metabolites, 2022]. IMPACT: Early indication of surgical efficacy, through an improved understanding of changes in cerebral physiology and anatomy after surgical intervention, has potential to improve management of treatment failures and therefore improve clinical outcomes. Website Link:

Supervising Institution:
Boston Children's Hospital

Pei-Yi (Ivy) Lin

Project Location:
Uganda, United States

Award Amount: