So they put shunts in babies that had hydranencephaly and Danny Walker malformation and all other kinds of anomalies. And so all those are in the denominator. So when you look at the numbers, it looks like there's no benefit. But if you actually pull that paper and scrutinize it, you see that the kids who had aqueductal stenosis in. On postnatal evaluation, those kids actually benefited.
Aqueductal stenosis is associated with poor neurologic outcomes, and back in the 1980s shunting was attempted because the prognosis was so poor and it was an obvious target because ultrasound was new.
In the 1980s fetal shunting for hydrocephalus was attempted but failed because accurate diagnosis of pressure hydrocephalus was not possible, leading to shunts being placed in babies with hydranencephaly, Dandy-Walker malformation, and other anomalies
Current management of fetal aqueductal stenosis is observation until near term (37 weeks) followed by assisted delivery, usually by cesarean section, sometimes classical cesarean with vertical skin incision due to large head size
quoteAqueductal stenosis is associated with poor neurologic outcomes, and back in the 1980s shunting was attempted because the prognosis was so poor and it was an obvious target because ultrasound was new.↗
▶Ep 1 · 0:30
clinicalAqueductal stenosis is associated with poor neurologic outcomes↗
▶Ep 1 · 0:40
clinicalIn the 1980s fetal shunting for hydrocephalus was attempted but failed because accurate diagnosis of pressure hydrocephalus was not possible, leading to shunts being placed in babies with hydranencephaly, Dandy-Walker malformation, and other anomalies↗
▶Ep 1 · 1:10
quoteSo they put shunts in babies that had hydranencephaly and Danny Walker malformation and all other kinds of anomalies. And so all those are in the denominator. So when you look at the numbers, it looks like there's no benefit. But if you actually pull that paper and scrutinize it, you see that the kids who had aqueductal stenosis in. On postnatal evaluation, those kids actually benefited.↗
▶Ep 1 · 1:30
clinicalWhen the 1980s shunting data are scrutinized, babies who had aqueductal stenosis on postnatal evaluation actually benefited from shunting↗
▶Ep 1 · 1:50
quoteIFMSS put a moratorium on shunting in 1986, and there's been just crickets since.↗
▶Ep 1 · 1:50
guidelineIFMSS put a moratorium on fetal shunting in 1986↗
▶Ep 1 · 2:00
clinicalCurrent management of fetal aqueductal stenosis is observation until near term (37 weeks) followed by assisted delivery, usually by cesarean section, sometimes classical cesarean with vertical skin incision due to large head size↗
▶Ep 1 · 2:30
clinicalThe research team developed an animal model that reliably and reproducibly generates mid-trimester hydrocephalus and designed a shunt device from scratch that is near design freeze↗
▶Ep 1 · 3:00
opinionDecompressing intracranial pressure with a shunt will allow the fetal brain to continue to develop normally and heal from injury that has already occurred↗
▶Ep 1 · 3:35
clinicalThe research agenda presented in 2014 at IFMSS received phenomenal support from the investigators who instituted the 1986 moratorium, including Mike Harrison and Bill Kluwell↗
▶Ep 1 · 4:21
opinionThe hydrocephalus shunt is purpose-designed specifically for fetuses, which is very unique in fetal medicine where devices are usually borrowed from other applications↗
▶Ep 1 · 4:40
quoteThis new problem allowed us to start from scratch. Just like forget what they tried before. Forget what we're doing for bladder shunts. That's not what we need. We need this thing that has these certain performance characteristics.↗
Steven's statements about Hydrocephalus13 statements
quoteAqueductal stenosis is associated with poor neurologic outcomes, and back in the 1980s shunting was attempted because the prognosis was so poor and it was an obvious target because ultrasound was new.↗
▶Ep 1 · 0:30
clinicalAqueductal stenosis is associated with poor neurologic outcomes↗
▶Ep 1 · 0:40
clinicalIn the 1980s fetal shunting for hydrocephalus was attempted but failed because accurate diagnosis of pressure hydrocephalus was not possible, leading to shunts being placed in babies with hydranencephaly, Dandy-Walker malformation, and other anomalies↗
▶Ep 1 · 1:10
quoteSo they put shunts in babies that had hydranencephaly and Danny Walker malformation and all other kinds of anomalies. And so all those are in the denominator. So when you look at the numbers, it looks like there's no benefit. But if you actually pull that paper and scrutinize it, you see that the kids who had aqueductal stenosis in. On postnatal evaluation, those kids actually benefited.↗
▶Ep 1 · 1:30
clinicalWhen the 1980s shunting data are scrutinized, babies who had aqueductal stenosis on postnatal evaluation actually benefited from shunting↗
▶Ep 1 · 1:50
guidelineIFMSS put a moratorium on fetal shunting in 1986↗
▶Ep 1 · 1:50
quoteIFMSS put a moratorium on shunting in 1986, and there's been just crickets since.↗
▶Ep 1 · 2:00
clinicalCurrent management of fetal aqueductal stenosis is observation until near term (37 weeks) followed by assisted delivery, usually by cesarean section, sometimes classical cesarean with vertical skin incision due to large head size↗
▶Ep 1 · 2:30
clinicalThe research team developed an animal model that reliably and reproducibly generates mid-trimester hydrocephalus and designed a shunt device from scratch that is near design freeze↗
▶Ep 1 · 3:00
opinionDecompressing intracranial pressure with a shunt will allow the fetal brain to continue to develop normally and heal from injury that has already occurred↗
▶Ep 1 · 3:35
clinicalThe research agenda presented in 2014 at IFMSS received phenomenal support from the investigators who instituted the 1986 moratorium, including Mike Harrison and Bill Kluwell↗
▶Ep 1 · 4:21
opinionThe hydrocephalus shunt is purpose-designed specifically for fetuses, which is very unique in fetal medicine where devices are usually borrowed from other applications↗
▶Ep 1 · 4:40
quoteThis new problem allowed us to start from scratch. Just like forget what they tried before. Forget what we're doing for bladder shunts. That's not what we need. We need this thing that has these certain performance characteristics.↗
