The Hydrocephalus Program

In 2003, the University of Calgary’s adult hydrocephalus clinic was established with the goal to standardize and enhance the care for adult patients with hydrocephalus. Hydrocephalus patients had typically been assessed and cared for by individual physicians in an unstructured and unfocused clinic environment. The population of adult patients with hydrocephalus is increasing as diagnostic and therapeutic techniques improve identification and survival. Hydrocephalus represents a treatable cause for approximately five per cent of adult patients with a diagnosis of dementia.

The Adult Hydrocephalus Program was developed in response to the strengths of the adult hydrocephalus clinic. A clinical research program was initiated, and a basic science research program is in development. Targeting the care of adult patients with hydrocephalus in a specialty clinic has aided in understanding the natural history of adults with both treated and untreated hydrocephalus.

The program has helped to standardize the treatment strategies for patients with a potential diagnosis of hydrocephalus and it has helped to improve the management of patients using shunts and endoscopic techniques. In 2019, there were about 3,000 patients followed in the adult hydrocephalus clinic. There were approximately 1,500 outpatient assessments and 180 surgical procedures performed. The COVID pandemic adversely affected the ability to do clinic assessments and surgical procedures in 2020-2021. This has returned to pre-pandemic levels in late 2022. The clinic members participate in weekly rounds to plan patient assessments and treatment.

Highlights

• Dr. Hamilton is the chair for the Adult Hydrocephalus Clinical Research Network (AHCRN), which has two centers in Canada, five in the United States and one in England. AHCRN has enrolled >2,220 patients, has completed a pilot randomized clinical trial for patients with idiopathic normal pressure hydrocephalus and received NIH grant funding to undertake a multicenter randomized clinical trial to assess the effectiveness of shunt treatment in patients with idiopathic normal pressure hydrocephalus (www.AHCRN.org).
• Dr. Hamilton is a board member and immediate past-president of the Hydrocephalus Society—The International Society for Hydrocephalus and Cerebrospinal Fluid disorders (www.ISHCSF.com).
• Dr Hamilton is a co-chair of the Editorial Board of the Journal of Neurosurgery and on the Editorial Boards of Neurosurgery, Fluids and Barriers of the CNS and the Canadian Journal of Neurological Sciences.
• Dr. Hamilton is a member of the board of directors of the Hydrocephalus Association and the vice-chair of the medical advisory board of the Hydrocephalus Association (www.hydroassoc.org).
• Dr. Hamilton is helping to develop a Canadian hydrocephalus strategy and he is a member of the board of directors of Hydrocephalus Canada, and the medical advisory board of Hydrocephalus Canada (which was inaugurated in November 2017).
• Multiple quality improvement projects have been undertaken to improve patient access, surgical techniques for hydrocephalus care, and surgical outcomes.
• A formal protocol has been established to facilitate transition of care for pediatric patients with hydrocephalus when they turn 18 years of age
• Working with the Public Health Agency of Canada to reduce shunt surgery infections in Canadian neurosurgical centers.

Education

The Hydrocephalus Program offers fellowship training for neurosurgeons interested in subspecialty training in the diagnosis and management of adult patients. The first trainee completed his fellowship training in June 2012. Dr Hamilton participates regularly in the local, provincial, national, and international education of Neurosurgeons and Neurologists regarding the diagnosis and treatment options for adult patients with a diagnosis of hydrocephalus.

Research

• Initiation of the Adult Hydrocephalus Clinical Research Network
• Epidemiology of hydrocephalus
• Transition care for pediatric patients with hydrocephalus
• Neuroendoscopy treatment and outcome for adult patients with hydrocephalus
• Neuropsychological effects of endoscopic treatment of patients with hydrocephalus
• Prevention of infections in patients with ventricular catheters and shunts
• Improving surgical outcomes and quality of life for treatment with ventriculoperitoneal and ventriculoatrial shunts
• Treatment of patients with idiopathic normal pressure hydrocephalus
• Endoscopic management of patients with brain tumors in the ventricles

Members

Neurosurgeons: Dr. Mark Hamilton, Dr. Clare Gallagher, Dr. Walter Hader

Medical and Surgical Assistant: Dr. Geberth Urbaneja

Neuro-ophthalmologists: Dr. Fiona Costello, Dr. Suresh Subramaniam

Geriatrician: Dr. David Hogan

Nurse Practitioners: Ron Prince, Patti Long

Research Manager: Jarred Dronyk