Hydrocephalus and cerebrospinal fluid (CSF) leaks stem from very different anatomical causes. But both fall under the umbrella of CSF disorders, conditions that change CSF pressure and lead to numerous related consequences, including a host of neurological symptoms. Though such disorders—which also include pediatric and adult hydrocephalus, Chiari malformations, pseudotumor cerebri, cerebral and spinal cord cysts, and periventricular tumors—are often treated in a fragmented fashion by different types of providers, concentrating expertise within a single group significantly benefits patients, says neurosurgeon Mark Luciano, who joined Johns Hopkins’ Department of Neurosurgery in August.
“These conditions as a group are difficult to treat effectively,” he says. “Patients often lack specialists in CSF disorders with the necessary knowledge to fully address their condition.”
That’s why Luciano and neurology colleague Abhay Moghekar co-direct the Cerebral Fluid Center at Johns Hopkins, where other neurosurgeons, neurologists, pain experts and therapists treat patients together.
One of the most common disorders seen through the program is adult hydrocephalus, explains Moghekar. Though hydrocephalus is often thought of as a pediatric disorder, it’s typically treated with shunts, which require lifelong care. Patients who age out of pediatric care can have difficulty finding a specialist willing to follow up with them in adulthood. “We can help patients make a comfortable transition from pediatric to adult care,” Moghekar says.
Adults also suffer from a unique type of hydrocephalus known as normal pressure hydrocephalus (NPH). This problem can be difficult to diagnose because its constellation of symptoms, including gait disturbance, urinary incontinence and cognitive problems, are common to many other diseases. NPH in particular requires the type of comprehensive, multidisciplinary care available only through a model like the Cerebral Fluid Center.
When patients come in for an NPH evaluation, Moghekar explains, a physical therapist tests their gait and balance, and a neurologist provides a comprehensive neurologic workup to assess for all potential diagnoses. If NPH is suspected, a spinal tap is performed with quantitative testing of gait and balance to determine if the patient would benefit from a shunt. If the patient’s gait improves after the spinal tap, then it’s a positive sign that a shunt might provide long-lasting relief, and the patient is referred to Luciano for shunt surgery.
Other conditions under the CSF disorders banner require their own
unique amalgamation of expertise, Luciano adds, including geriatrics,
ophthalmology, pain medicine and other specialties. “We truly provide a comprehensive combination of medical and surgical services to treat patients as effectively as possible.”