A GLYMPSE into the disorders of CSF circulation in children

Administrator: Mahendra Moharir, Canada

Dr. Mahendra Moharir
Division of Neurology, The Hospital for Sick Children and University of Toronto Toronto
mahendranath.moharir@sickkids.ca
Breaking the Age Old Dogma in Neuroscience
Dr.Moharir is an academic clinician with main interest in pediatric stroke research with focus on cerebral venous thrombosis. However he also has wider interests in general neurology in particular IIH (given the presence of abnormalities in the venous system) and has been intrigued by the emerging role of glymphatic system in IIH, which really has been the stimulus for conceptualizing this symposium. In the introductory brief talk (10min), he will discuss objectives of the symposium and set the stage for the following speaker presentations by providing a high level overview of the recently discovered glial and meningeal lymphatic system of the brain in animal models and humans. The presentation will provide a brief overview of how the glial lymphatic system in particular is beginning to provide early insights and contributions into our understanding of many neurological disorders. However essentially all emerging literature is predominantly in commonly prevalent adult neurological conditions like Alzheimer's Disease, Sleep Disorders, Stroke, Traumatic Brain Injury etc. Unfortunately, there is essentially very little research done to date in exploring the role of the glial lymphatic system in pediatric neurological disorders. Hence, the overarching purpose of the symposium to educate the attendees in the concept of the glial lymphatic system and stimulate productive research ideas to study the role of the glymphatic system specifically in pediatric neurological conditions.

Dr. Juan Piantino
Section in Child Neurology, Dept of Pediatrics, Oregon Health and Sciences University, Portland, Oregon
piantino@ohsu.edu
The glymphatic system: the new frontier in fluid dynamics of the brain and neurological disorders?
Dr.Piantino is a clinician-scientist in pediatric neurointensive care with interest in pediatric neurocritical disorder investigation, recovery and outcomes. He is pursuing NIH grant funded (early career grants) work in glymphatic system impairment in pediatric TBI. This presentation will be a “beginner’s guide” to the understanding of the glial lymphatic system and the meningeal lymphatic system of the brain. The glymphatic system is a brain wide network that supports fluid movement through the cerebral parenchyma and the clearance of interstitial solutes and wastes from the brain. The lecture will focus on the glial lymphatic system and it’s role in waste clearance from CSF and intracranial fluid circulation. The lecture will then review the neuroimaging perspectives in demonstration of the glial lymphatic system. Since the glymphatic system is active primarily during sleep, the presentation will also review the potential role in sleep disorders. Novel techniques, which are being developed to examine glymphatic function in humans and to explore potential interventions to alter glymphatic exchange that may offer a novel therapeutic approaches to cerebral edema management and TBI will be presented. Lastly, practical approaches to cerebral edema management will be covered and discussed in the backdrop of the glymphatic system.

Dr. Richard Edwards
Dept of Neurosurgery, Bristol Royal Hospital for Children, Bristol
richard.edwards@nbt.nhs.uk
Pediatric Hydrocephalus: What’s New and What Should a Pediatric Neurologist Know?
Dr. Edwards is a pediatric and adult neurosurgeon and has a major clinical and research interest in surgery for hydrocephalus and other CSF circulation disorders. He lectures internationally in this field and runs courses in both Europe and Asia to train neurosurgeons in the management of complex hydrocephalus. He has established himself as a leading world authority in hydrocephalus. The lecture will review the fundamental concepts of CSF circulation, principles of fluid dynamics as applicable to the cranial vault and pathophysiologic mechanisms of hydrocephalus in children. The talk will also specifically discuss the potential contributions of the recently discovered glial lymphatic system in the pathophysiology of hydrocephalus. Thereafter, common investigative and management approaches as well as outcomes in pediatric hydrocephalus will be reviewed with focus on aspects relevant to pediatricians and pediatric neurologists. Finally recent advances in management and future emerging therapies will be presented.

Dr. Daniel Tibussek
Pediatric Neurologist, Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children´s Hospital, Heinrich-Heine University, Düsseldorf
daniel.tibussek@gmx.net
Pediatric Idiopathic Intracranial Hypertension: Has the chicken or the egg question been resolved?
Dr. Daniel Tibussek is a clinical and academic pediatric neurologist with clinical and research interest in pediatric intracranial hypertension (IIH) (pseudotumor cerebri), among other interests such as pediatric stroke. He has published extensively in pediatric IIH. He is a long serving Principal Investigator of the German Pediatric Pseudotumor Cerebri Surveillance Network since 2007. His presentation will be a refresher on the clinical presentation, imaging, investigation, management approach and outcomes in pediatric IIH. However, the thrust of his presentation will be on the controversies surrounding the pathogenetic mechanisms of IIH and intracranial venous hypertension particularly in light of the emerging literature on purported contributions by the glial lymphatic system and meningeal lymphatic system. Finally, the lecture will also review the role of the controversial and highly invasive, lifelong, irreversible intervention, intracranial venous sinus stenting, which is being increasingly offered in children with refractory IIH based on adult practice.