Hydrocephalus is the most frequent reason children undergo brain surgery. We're working on a better way.
Cure Hydrocephalus is a research initiative led by Dr. Satish Krishnamurthy, a pediatric neurosurgeon with more than twenty peer-reviewed publications on hydrocephalus. Our work is built on a reframing of the disease — and on the medications that reframing makes possible.
Hydrocephalus may not be primarily a plumbing problem.
For decades, hydrocephalus has been treated as a circulation failure — cerebrospinal fluid can't get out, so we drain it surgically. Our research proposes a different model: the brain is permeable to water through aquaporin channels, and hydrocephalus is driven in large part by the buildup of macromolecules that disrupt normal transport.
When macromolecules — larger proteins and similar particles — accumulate in cerebrospinal fluid, they pull water in by osmosis. The result is hydrocephalus, even when nothing is mechanically blocked. If macromolecular buildup is a driver of the disease, then clearing those macromolecules pharmacologically — instead of, or alongside, draining fluid surgically — becomes a real therapeutic possibility.
Pathophysiology: hydrocephalus as a macromolecular transport disorder
Peer-reviewed work reframing hydrocephalus — including dose-dependent hydrocephalus from osmotic loading, delayed macromolecule clearance in patients, the role of p-glycoprotein efflux transporters, and implications for long-duration spaceflight.
Read the full research →Shunt technology: improving care for patients today
Practical advances for patients currently living with shunts — ultrasonic CSF flow sensing, ultrasound-guided catheter placement, the Grotenhuis perforator for safer ETV, MRI-compatible programmable valves, and infection-reduction protocols.
Read the full research →A pediatric neurosurgeon, and the patients who got him here.
Dr. Satish Krishnamurthy, MD
Dr. Krishnamurthy has dedicated his career to researching hydrocephalus and related disorders. He has treated hundreds of children with hydrocephalus and authored more than twenty peer-reviewed publications on the condition. He is widely recognized as a global expert on hydrocephalus.
His motivation is direct: the fatigue, trauma, and pain of multiple brain surgeries in young children. He believes a medication-based alternative is possible — and his published work outlines the scientific basis for pursuing it.
What hydrocephalus is, how it's treated, and what comes next.
Every page here is written and reviewed by a practising pediatric neurosurgeon.
Understanding hydrocephalus
What it is, who it affects, and what's happening in the brain. Pediatric, adult, and normal pressure hydrocephalus (NPH).
Start here →Treatment today
Shunts, endoscopic third ventriculostomy (ETV), what surgery involves, and how care is changing.
Read more →Living with hydrocephalus
Long-term outlook for children, adults, and families — and where to find community and ongoing care.
Read more →Sixteen studies, and what each one found.
Two decades of work in two threads: why hydrocephalus happens, and how to make today's treatment safer.
Stream 1 · Pathophysiology of hydrocephalus
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Intraventricular infusion of hyperosmolar dextran induces hydrocephalus: a novel animal model of hydrocephalus.
Shows that infusing excess macromolecules causes hydrocephalus even when fluid pathways are clear — direct evidence that the disease is not purely a circulation problem.
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Increased CSF osmolarity reversibly induces hydrocephalus in the normal rat brain.
Demonstrates that increasing the osmotic load in ventricular fluid produces hydrocephalus in a dose-dependent way — and that the effect reverses when osmolarity returns to normal.
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Normal macromolecular clearance out of the ventricles is delayed in hydrocephalus.
Patient data showing that macromolecular clearance is impaired in hydrocephalus — the clinical correlate of the experimental work above.
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New concepts in the pathogenesis of hydrocephalus.
A review proposing that hydrocephalus is better understood as a disorder of macromolecular clearance than as a circulation failure — with osmotic gradients driving the abnormal water content of the ventricles.
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A proposed role for efflux transporters in the pathogenesis of hydrocephalus.
Frames efflux transporters as the brain's "vacuum cleaners" for macromolecules, with p-glycoprotein identified as central to clearance — and individual variability in p-gp expression possibly explaining differences in hydrocephalus risk after intraventricular hemorrhage.
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Dynamic disequilibrium of macromolecular transport as possible mechanism for hydrocephalus associated with long-term spaceflight.
Proposes that microgravity creates a dynamic disequilibrium of macromolecular transport across the blood-brain barrier — a natural experiment in support of the model.
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Do P-glycoprotein medications alter the risk of ventriculoperitoneal shunt in adults with hydrocephalus?
Retrospective analysis of 4,588 adults with hydrocephalus showing that exposure to P-glycoprotein inhibitors was associated with a 3.2× higher risk of requiring VP shunt surgery — direct clinical evidence linking P-gp pharmacology to hydrocephalus outcomes in humans.
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Pathophysiologic mechanisms and strategies for the treatment of post-hemorrhagic hydrocephalus of prematurity.
Systematic review of 58 studies on post-hemorrhagic hydrocephalus in premature infants, finding that the condition is multifactorial — mechanical obstruction of CSF pathways alone does not predict who develops it, pointing to additional pathophysiologic drivers beyond simple blockage.
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Scoping review of the risk factors and time frame for development of post-traumatic hydrocephalus.
Scoping review of 27 studies identifying statistically significant demographic, clinical, radiographic, and surgical risk factors for post-traumatic hydrocephalus, along with a predictive time frame for onset — to support timely diagnosis in patients recovering from traumatic brain injury.
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Abnormal transcytosis mechanisms in the pathogenesis of hydrocephalus: a review.
Reviews how mutations in α-SNAP and SNARE complexes disrupt vesicular trafficking and transcytosis, impairing macromolecular clearance from CSF — a molecular mechanism that directly supports the macromolecular transport model of hydrocephalus.
Stream 2 · Improving shunt technology
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Noninvasive measurement of cerebrospinal fluid flow using an ultrasonic transit time flow sensor: a preliminary study.
Measures shunt output within ± 15% or ± 2 ml/hr — making shunt failure detectable from real-time, continuous flow data, without imaging.
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Strategic placement of bedside ventriculostomies using ultrasound image guidance: report of three cases.
Demonstrates that ultrasound-guided placement allows customized catheter trajectories to accommodate distorted and dynamic ventricular anatomy.
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Bedside external ventricular drain placement: can multiple passes be predicted on the computed tomography scan before the procedure?
Analyzes 47 EVD placements and finds no statistical relationship between number of passes and hemorrhage rate — with implications for procedural risk and pre-procedure planning.
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Use of Grotenhuis perforator in endoscopic third ventriculostomy and cyst fenestration.
Retrospective review of 23 patients showing no basilar artery injuries or serious complications when using the Grotenhuis perforator during ETV or cyst fenestration.
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Radiation risk due to shunted hydrocephalus and the role of MR imaging-safe programmable valves.
Examines cumulative radiation exposure in shunted patients and identifies which programmable shunt valves remain unaffected in 3T MR imaging fields — supporting safer follow-up imaging without repeated CT.
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Evidence-based perioperative protocol for ventriculoperitoneal shunt infection reduction at a single institution.
Developed an evidence-based perioperative protocol; comparing 226 pre-protocol and 285 post-protocol patients, observed a trend toward fewer shunt infections (8.8% → 5.6%).
Collaborate with us
Clinician-scientists, pharmacologists, and patient advocates working on CSF biology, aquaporin pharmacology, pediatric neurosurgery, or NPH research: we want to hear from you.
Coverage of our work.
- HealthLink on Air · The Informed Patient 2024 Optimizing how medications reach the brain
- HealthLink on Air · The Informed Patient 2024 Team seeks new ways to relieve fluid buildup in the brain
- Upstate News 2024 Upstate, Binghamton combine strengths for research on hydrocephalus
- Binghamton University News 2024 Researchers from Watson College, Upstate Medical team up to study brain disease
- Upstate News 2022 Upstate scientists collaborate on hydrocephalus research
- Spectrum News 1 2021 CNY doctor looking for a drug to cure hydrocephalus
- What's Up at Upstate 2019 Rethinking hydrocephalus: would a medication work better than surgery?
- HealthLink on Air 2019 Neurosurgeon considers new ways to treat the excess fluid of hydrocephalus
- HealthLink on Air 2016 Neurosurgeon, patient's family seek better solution to hydrocephalus
- Upstate News 2016 Hydrocephalus research receives $10,000 in support from grateful patient family
- Spectrum News 1 2015 Researchers continue work to find cure for hydrocephalus
Help fund non-surgical treatments for children with hydrocephalus.
Cure Hydrocephalus operates under the fiscal sponsorship of REaCH Org, a registered 501(c)(3). Donations are tax-deductible to the extent allowed by law and go directly to research and education — there is no paid staff and no administrative overhead.