Doctors try new shunt-free treatment at Primary Children's Hospital

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SALT LAKE CITY — Doctors at Primary Children's Hospital are using a new technique to drain excess spinal fluid from children with hydrocephalus.

During a clinic visit, neurosurgeon Jay Riva-Cambrin checked out his patient 20-month-old Malakai McIntyre. Unlike his twin brother Elijah, Malakai was born with a small blockage in the brain that prevents the natural drainage and circulation of excess spinal fluid. Without treatment, the fluid builds in the brain, enlarging the skull. Children with this condition face serious developmental problems, even death.

Traditionally, an implanted artificial tube called a shunt drains the excess fluid from the brain into the child's abdominal cavity. It's been the workhorse treatment for hydrocephalus for the past 30 years, but shunts have issues.

According to Riva-Cambrin, "5 to 10 percent of shunts get infected, requiring two weeks in the hospital and two surgeries." Even worse, 40 percent of shunts become blocked and require surgery again within the first two years of the implant.

However, when Malakai was 2 1/2 months old, Riva-Cambrin and his colleagues tried something different.

In a procedure involving both sides of the skull, they snaked a small catheter through the brain canals, opening a new hole that would allow the spinal fluid to drain and circulate — naturally. The catheter is then retracted to another part of the brain to partially cauterize a structure that filters blood into spinal fluid. Surgeons cauterize the right side of this structure, then they make a small hole in the left part of the skull and cauterize the other side.

"There's nothing to get infected," Riva-Cambrin said. "There's no artificial tubing. Plus, we like the idea that the procedure reproduces the natural flow of spinal fluid in the brain."

Malachi's parents, Gavin and Melanie, said a coincidental two-week delay in originally treating their son's hydrocephalus paid off.

"In that two weeks, this new procedure was introduced and became an option," Melanie said. "It was sort of an answer to our prayers because we had been praying that whole time that something else would become available for our son other than implanting a shunt."

While not all infants are eligible, the new procedure is up to 70 percent effective in treating hydrocephalus in those like Malakai who have the surgery.

"It's completely stopped his head growth which was growing out of control," Riva-Cambrin said. "He had a soft spot which indicated there was pressure building in the brain. All that was relieved immediately after surgery."

In evaluating the data so far, Riva-Cambrin said, "We're seeing the use of shunts and shunt revisions going down dramatically in Salt Lake City. So we're putting ourselves out of business — and that's good."

However, Riva-Cambrin warned that shunts will never be eliminated because there are some cases, especially in older kids, in which the artificial tubing may be the only viable way to treat hydrocephalus.

Since Malakai and Elijah are twins, their parents and the medical staff at Primary Children's Hospital will find it easier to watch Malakai's development because they can compare his growth with that of his brother. So far, in walking, talking and playing, it's hard to see a difference now between the two boys.


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Ed Yeates


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