COSIMENA-funded Winter School on Neonatal Hydrocephalus: Defending A Morbid Disease
The first workshop of the Winter School provided an in-depth overview of neonatal hydrocephalus, focusing on its diagnosis, treatment, and ongoing challenges. It highlighted the need for tailored management strategies using advanced diagnostic tools such as MRI and CT scans. Key advancements in neuroendoscopic technology were discussed, including high-definition imaging and precision techniques, alongside limitations of traditional shunts and emerging approaches like Choroid Plexus Cauterization (CPC) and endoscopic lavage. The discussions emphasized the importance of multidisciplinary collaboration, further research, and innovative solutions to enhance patient outcomes.
The first workshop commenced with the presentation of Dr Heba Azouz, representing Prof. Dr Ahmed Zohdi from Cairo University, as an overview of hydrocephalus, focusing on its definition, types, and management. She explained that hydrocephalus results from abnormal cerebrospinal fluid (CSF) dynamics, which can cause decreased pressure or ventricular dilation. Congenital hydrocephalus affects 1 to 2 per 1,000 live births, while acquired cases stem from obstruction, infection, or trauma. “Hydrocephalus could be congenital or acquired, and the management must be tailored to each patient based on their specific condition,” she said. Diagnostic tools like ultrasound, MRI, and CT scans were highlighted, along with the role of endoscopic techniques, emphasising that successful outcomes depend on understanding individual anatomies and pathologies: “Hydrocephalus management is not a one-size-fits-all approach; it requires careful consideration of the patient’s condition.”
Prof. Dr Henry W.S. Schroeder from University Medicine Greifswald discussed advancements in neuroendoscopic technology, tracing its evolution from early models with poor illumination to modern systems with high-definition and 3D imaging. “The introduction of high-definition cameras in 2007 marked a significant milestone,” he said, noting the precision of rigid endoscopes and bipolar forceps for coagulation. He also highlighted challenges such as tissue damage risks and regulatory barriers that hinder adopting advanced tools like chip-on-tip endoscopes.
Discussing stenting in endoscopic ventricular surgery, Prof. Dr Ehab El Refaee from Cairo University and University Medicine Greifswald explained “The most common treatment is an AP shunt, which connects the ventricles to the peritoneal cavity.” He highlighted stents’ increasing use, particularly in complex cases like post-tumor recovery, stressing the need for precise placement to prevent migration and ensure drainage.
Prof. Dr Khaled Bassim from Cairo University reflected on hydrocephalus treatment advancements, acknowledging the limitations of shunts introduced in the 1950s: “Shunt can kill people… it’s not a perfect device.” He discussed complications like infections and shared his team’s success with Choroid Plexus Cauterization (CPC), achieving an 80-90% success rate, while calling for further research to enhance CPC’s effectiveness.
Assist. Prof. Dr Mohamed Elsawy from Cairo University introduced endoscopic lavage for intraventricular infections, emphasising its potential despite complications. He called for further research, noting its growing adoption in regions like Malaysia.
Prof. Dr Hassan Eissa, Evangelisches Krankenhaus Oberhausen, discussed neonatal care, focusing on intraventricular hemorrhage (IVH) in preterm infants. About 50% of IVHs occur within the first 24 hours, often leading to severe complications. “For over 100 years, we have tried various agents, but no treatment has proven successful,” he said, stressing the importance of early interventions.
Dr Reem Elwy from Cairo University presented findings on congenital hydrocephalus in Egypt, identifying risk factors such as inadequate maternal folic acid intake and low maternal education. “Hydrocephalus is more prevalent in lower-income countries, yet the literature from these regions is disproportionately sparse,” she noted, advocating for preventive strategies and more research.
In an interview, Prof. Dr Ehab El Refaee, discussed the value of the Winter School in advancing medical research and collaboration. “In the medical field, we often lack time for teamwork, which is crucial for building a research database,” he said. The winter school, structured partly as a competition, will divide participants into teams to work on joint research projects with University Medicine Greifswald. He emphasised the importance of involving fresh graduates, medical students, and experts from fields such as computer science to enhance research outcomes. “We need people from diverse specialties to work together for better research,” he added.
The second workshop explored hydrocephalus research and treatment advancements, emphasizing interdisciplinary approaches and innovative solutions. Discussions covered the use of animal models to explore therapies, advancements in fetal spina bifida repair for improved neurological outcomes, and the potential of endoscopic techniques like ETV-CPC in neonatal care. Emerging insights into CSF dynamics, lymphatic systems, and genetic factors highlighted the promise of molecular and imaging technologies for personalized therapies. The workshop also addressed the psychosocial and economic challenges in resource-limited settings, stressing the need for awareness and family support, while engineering innovations focused on refining shunting systems to enhance safety and efficacy.
Commencing the second workshop, Dr. med. Ahmed Almenabbawy, affiliated with University Medicine Greifswald and Cairo University, shared insights from his research on cognitive impairment and hydrocephalus models. With experience managing hydrocephalus since 2015 and certifications in Egypt and Germany, he emphasised the critical role of animal models in exploring therapeutic methods, including medications and surgical techniques. Commonly studied animals include rabbits, rats, mice, and gyrencephalic species like pigs and monkeys, preferred for their resemblance to human brain structures.
Dr Heba Azouz from Cairo University highlighted advancements in fetal repair of spina bifida, focusing on topology and dynamic regulation in fetal development. Her research, involving 50 procedures on 48 patients, demonstrated statistically significant correlations between ventricular size and neurological outcomes. She explained that repairing spina bifida in utero allows for near-normal brain development, especially in early interventions. Comparative illustrations showed differences in spinal curvature and their implications for treatment outcomes. She emphasised the need to improve intrauterine treatment protocols and Adjusted Clinical Groups (ACG) success scores to enhance outcomes in spina bifida cases.
Discussing innovative approaches in neonatal care, Prof. Dr Assem Mounir from Ain Shams University focused on endoscopic techniques for treating hydrocephalus. He highlighted the evolution of methods like endoscopic third ventriculostomy with choroid plexus cauterization (ETV-CPC), which offers promising results but still requires refinement. He stressed the importance of unified definitions and improved treatment modalities to optimize outcomes and guide future research.
Dr med. Florian Siegerist from University Medicine Greifswald presented recent advances in neonatal hydrocephalus, emphasising the evolving understanding of cerebrospinal fluid (CSF) dynamics and lymphatic drainage. “There is an intracerebral lymphatic system,” he noted, a paradigm shift confirmed by advanced imaging techniques. He also discussed the role of inflammation, fibrosis, and CSF hypersecretion in post-infection hydrocephalus, as well as genetic mutations identified in congenital cases. He expressed optimism for molecular sequencing and novel imaging approaches to develop patient-centered therapies.
Dr Sylvia Shitsama from Jomo Kenyatta University of Agriculture and Technology addressed the psychosocial and economic impacts of pediatric hydrocephalus, particularly in resource-limited regions. She highlighted the financial and educational challenges families face in managing the condition, compounded by traditional healthcare practices and a lack of awareness about modern treatments. “The lack of education, especially in high-risk areas, is a significant challenge,” she emphasised, calling for increased awareness and support for affected families.
Dipl. Eng. Roland Schulz, vice president of Christoph Miethke GmbH & Co KG, discussed engineering challenges in pediatric hydrocephalus treatment, focusing on shunting systems. He noted the complexities of managing intracranial pressure (ICP) in lying and standing positions and advocated for shunts with gravitational compensation to stabilize Increased intracranial pressure (ICP). Addressing issues like valve obstruction and infection, he emphasised precise catheter placement and the role of lavage in reducing complications.
During the Q&A sessions, participants discussed the challenges of coordinating multidisciplinary teams for complex medical procedures, particularly surgeries in Egypt. The conversation emphasized the difficulty of aligning obstetricians, neurosurgeons, anesthesiologists, ultrasound technicians, and Neonatal intensive care unit (NICU) staff. Questions were raised about the use of TGF-Beta inhibitors, immune-modulating drugs, and the potential of VR simulation in surgical training. Discussions also explored the development of VR systems for training surgeons in neonatal procedures and advancements in sensor technology for measuring pressure in shunt systems.
The third workshop addressed how Artificial intelligence (AI) is transforming surgery, offering clinical and educational advancements. Prof. Dr Mahmoud Elfiky, a general surgeon at Cairo University, explained how AI enhances precision and reduces errors in surgical procedures. “AI technologies like augmented reality assist surgeons by overlaying images of critical structures during surgery, making complex procedures like orthopedic and fine surgeries more manageable,” he said. AI is also revolutionizing training through 3D printed models and augmented reality, allowing trainees to refine skills, monitor progress, and minimize mistakes. Additionally, neural networks aid decision-making, improving pre-surgery planning and predicting complications, resulting in better healthcare management and outcomes.
Dr Ahmed Almenabbawy, discussed virtual reality (VR) and augmented reality (AR) in hydrocephalus surgery. VR enables surgeons to visualize anatomy and plan procedures, which enhances patient education. “We can use VR to explain the surgical procedure to patients, helping them imagine it more vividly than just on paper,” he noted. He also shared his experience using VR for hemifacial spasm treatment, incorporating facial recognition and machine learning to assess severity and predict outcomes. AR, he explained, facilitates real-time navigation in complex procedures and offers the potential for non-invasive shunt monitoring. “We are now at the cusp of a technological revolution,” he emphasised.
Constantin Klaffus from University Medicine Greifswald, an undergraduate student at the University Medicine Greifswald explored AI’s role in diagnosing and treating hydrocephalus. He highlighted how AI accelerates tasks like processing medical images, citing a study where deep learning models demonstrated impressive accuracy in diagnosing obstructive hydrocephalus. While acknowledging AI’s limitations, Klaffus stressed its value as a tool under physician supervision, stating, “It is still very important that AI should be supervised by experienced human physicians, and it does not replace human expertise.”
Dr Caroline El-Sabty, a lecturer at the German International University (GIU), highlighted machine learning’s applications in predicting outcomes for infantile epilepsy. She explained how machine learning models utilize EEG records, patient histories, and clinical images to predict outcomes like seizure detection and drug resistance. “It will never replace the expertise of the actual human being, but it will make things faster and easier,” she said, addressing challenges like data privacy and generalization across populations.
Dr Mostafa Alaa, a VR researcher at Ulm University, discussed VR’s applications in neurosurgery, including trajectory planning, imaging visualization, and surgical training. “To create an authentic VR experience, you need to have a combination of immersive displays and accurate head tracking,” he explained. He acknowledged challenges like cost and accuracy but emphasized VR’s potential to transform the field.
Prof. Dr Ahmed El Harouni, an NVIDIA expert, discussed AI’s role in medical imaging, introducing MoMA, an open-source platform revolutionizing diagnostics and treatment planning. “MoMA bridges the gap between research and real-world patient care,” he said, showcasing its role in advancing AI innovation in healthcare.
At the end of the first day, Salma Sabri, a fourth-year medical student at Qasr El Aini, shared her experience with the German exchange program, explaining how her passion for neurosurgery grew after a module setback. Combining travel and neurosurgery, the program offered five days of intensive learning, including hospital experience and visits to the anatomy institute. “I got to experience things I did not think I would at my age, like working with robots and witnessing live neurosurgeries,” Salma reflected.
Fatma Soliman, Deputy Director of the German Academic Exchange Service (DAAD), opened the second day by highlighting the importance of cross-border scientific collaboration, stating, “Scientific cooperation across borders is the key to solving our global problems.” She celebrated DAAD’s 100-year milestone and 65 years of its Cairo office, noting over 2,000 alumni serving in universities and ministries since 1966. Soliman expressed gratitude to partners, including the German Embassy in Cairo, and emphasised the alumni’s role in strengthening ties between German and Egyptian institutions.
Annika Kraemer, Deputy Head of the Culture and Science Department at the German Embassy in Egypt, expressed enthusiasm for the event, emphasising its role in fostering cross-border research. “Your expertise and dedication are what make this event truly special,” she said, lauding Egyptian-German collaboration in neurology and neurosurgery and encouraging discussions to inspire new partnerships and solutions.
Prof. Dr Ahmed Zohdi,Cairo University, stated that the winter school harvested in seven projects aimed at enhancing high-risk diagnostic tools, such as AI for medical detection and VR for surgical training, praising participants for their innovative contributions.
Eng. Mostafa Hammouda introduced the Zahra Foundation, which provides integrated care for hydrocephalus patients, covering diagnosis, surgery, and long-term follow-up. Founded on Prof. Dr Ashraf Mansour’s personal experience, the foundation eliminates waiting lists through partnerships with 3,000 hospitals and funds surgeries, including those performed by Prof. Dr Ehab El Refaee. Eng Hammouda emphasised the foundation’s commitment to medical, psychological, and social support.
Prof. Dr med. Ehab El Refaee shared his experience managing neonatal hydrocephalus, discussing a complex case requiring multiple surgeries and highlighting the importance of perseverance: “We will never lose hope.”
Dr med. Michael Elsaesser from Heidelberg University Hospital discussed intrauterine myelomeningocele (MMC) repair, emphasising early identification through advanced imaging and the need for interdisciplinary teamwork for optimal outcomes. He noted postoperative care challenges and the variability in delivery timing.
Dr med. Ahmed El Damaty of Heidelberg University presented on fetal Myelomeningocele (MMC) repair, citing positive outcomes like independent walking in 70% of children but acknowledging challenges such as repair site complications and subsequent cesarean delivery risks.
Honorary speeches by Prof. Dr Ashraf Mansour, President of the German University in Cairo (GUC). Prof. Dr Abdelmeguid Kassem, Vice Dean for Postgraduate Affairs of Faculty of Medicine at Cairo University, and Prof. Dr. Lamia Mohsen, Founding Dean of the Faculty of Medicine at New Giza University (NGU),emphasised collaboration and innovation in tackling medical challenges, celebrating the event’s impact on fostering partnerships and solutions. Seven innovative projects were presented by the students of the winter school to tackle challenges in hydrocephalus and related conditions through advanced technologies and medical solutions.
The first project, “Hydrohope,” introduced a mobile application for children with hydrocephalus. Designed for Android and iOS, the app combines a mobile hospital system with AI-powered features for real-time support, secure medical tracking, and educational resources. During the Q&A, the team reassured the audience about the app’s robust security and compatibility while emphasising its potential to improve access to healthcare.
The second project, “Fetal Repair for MMC,” proposed establishing a specialized fetal clinic in Egypt to treat Neonatal Meningomyelocele (MMC). The clinic aims to reduce complications through tailored treatment protocols and collaboration with international experts. The team highlighted the clinic’s focus on ethical principles and patient-centered care during the Q&A session, addressing concerns about high hospital costs and emphasizing the need for multidisciplinary approaches.
“Revolutionizing Hydrocephalus Treatment: Collaborative Training with Virtual Reality” presented a VR-based platform for surgical training. It features realistic models, real-time feedback, and gamified learning systems to foster global collaboration. During the Q&A, the team detailed their use of genetically modified models, plans to scale difficulty levels, and efforts to integrate feedback from medical professionals to refine the platform.
The fourth project, “AI Implementation for Prediction of CSF Diversion Failure Risk,” relied on AI to predict cerebrospinal fluid (CSF) diversion failures. By integrating data from institutions like NIMF, the platform uses deep learning for enhanced accuracy. The team addressed questions on data integration, explaining how the model continuously updates with new data to improve predictions while maintaining user-friendliness for physicians.
“A Novel Tool to Predict Shunt Need in Severe Intraventricular Hemorrhage of Prematurity“, marking the fifth project,aimed to assess shunt requirements in premature infants through advanced modeling systems. The project emphasises accurate risk evaluation to improve outcomes. The team outlined their plans for further studies to validate the tool’s real-world effectiveness.
The sixth project, “Non-invasive ICP Monitoring through MRI Volume Measurements” sought to reduce shunting procedures using tools like MRI volumetry and ultrasound, supported by AI algorithms. The team emphasised the collaborative role of software engineers and surgeons in developing these technologies and explained how AI would autonomously assist in identifying fluid volumes over time.
Finally, “Egyptian EVD” aimed to produce a cost-effective external ventricular drain (EVD) system for Egypt. Incorporating innovative components like bacterial filters and electronic transducers, the system addresses infection risks and affordability. The team discussed their focus on accessibility and the importance of reducing reliance on expensive imported systems.
The winners were “AI Implementation for Prediction of CSF Diversion Failure Risk,” which took the first place, where Alaa Ashraf Abdelwahab and Mariam Kashif, team members, shared that their participation was a last-minute decision, inspired by a partnership with medical students to address gaps in existing models. Abdelwahab explained that their focus on explainable AI aims to offer predictive insights beyond mere outcomes, with plans to expand this work in his thesis. Kashif expressed her excitement for the project’s potential, viewing it as a foundation for further research at the intersection of AI and healthcare.
“Revolutionizing Hydrocephalus Treatment with Virtual Reality” came at the second place, where Dr Mahmoud Bassioni, the team leader, explained, “We provide a risk-free setting for training, so they can heighten their skills and familiarize themselves with various pathologies.” The platform integrates educational tools, VR models, and a collaborative network of international experts. With a one-year timeline for prototype development, Bassioni highlighted the need for ongoing support to achieve their goals. Lastly, “Fetal Repair for MMC” took the third place.
In conclusion, the two-day winter school on neonatal hydrocephalus successfully addressed critical issues in the diagnosis and treatment of this complex condition. Key highlights included the exploration of advanced neuroendoscopic techniques, the potential of AI, VR, and AR technologies in medical education and diagnostics, and the importance of individualized treatment strategies. The event fostered interdisciplinary collaboration, resulting in seven innovative research projects and underscoring the significance of global scientific cooperation to advance neonatal healthcare.
