Cerebral edema is associated with traumatic brain injury. The overall HYPOTHESIS of the proposed intervention is that free water removed from the brain following traumatic injury will minimize cerebral edema. Approach: The applicant proposes to complete preclinical development of an innovative catheter for the reduction of cerebral edema. The initial clinical application of this catheter will be traumatic brain injury, and will involve replacing standard ventricular drains with Water Removal Therapy (WRT) catheters that 1) remove fee water from the CS, 2) remove bulk cerebral spinal fluid (CSF) samples, and 3) monitor intracranial pressure. Removal of water free will increase osmolarity of the CSF, which will theoretically result in removal of interstitial brain water and improved nutrient exchange, creating improved cerebral perfusion. Phase I studies have demonstrated that human CSF osmolarity increases with traumatic brain injury and WRT catheters can remove water from CSF at clinically significant rates that improves water movement in ex vivo ovine cerebral tissue.
Specific Aims : (1) Build and test WRT catheters in vitro to meet human study requirements. (2) Test WRT catheters in vivo in a non-injury swine model. These tests will establish device safety under different operating parameters. (3) Measure cerebral changes (pressure and swelling) and functional outcome with ventricular WRT catheter treatment in vivo after cold freeze injury in swine model. Acute (6 hours) and chronic (1 week) randomized controlled injury studies will be undertaken. Significance: Cerebral edema after traumatic injury and severe stroke is a life threatening condition that is refractory to conventional treatments in a significant population of patients. Current treatments (i.e. hyperventilation, osmotic agents, or hypothermia) are associated with serious side effects that increase with prolonged use. Successful completion of Phase II aims will make human studies of WRT catheters possible. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Small Business Innovation Research Grants (SBIR) - Phase II (R44)
Project #
5R44NS043832-03
Application #
7123871
Study Section
Special Emphasis Panel (ZRG1-BDCN-K (10))
Program Officer
Hicks, Ramona R
Project Start
2002-05-01
Project End
2009-08-31
Budget Start
2006-09-01
Budget End
2009-08-31
Support Year
3
Fiscal Year
2006
Total Cost
$630,529
Indirect Cost
Name
Twin Star Medical
Department
Type
DUNS #
076324156
City
St Paul
State
MN
Country
United States
Zip Code
55114
Odland, Rick M; Venugopal, Sandya; Borgos, John et al. (2012) Efficacy of reductive ventricular osmotherapy in a swine model of traumatic brain injury. Neurosurgery 70:445-54; discussion 455
Odland, Rick M; Panter, S Scott; Rockswold, Gaylan L (2011) The effect of reductive ventricular osmotherapy on the osmolarity of artificial cerebrospinal fluid and the water content of cerebral tissue ex vivo. J Neurotrauma 28:135-42