# Dynamic Near-Infrared Fluorescence Imaging of CSF Outflow: A Tool to Manage Pediatric Hydrocephalus

> **NIH NIH R21** · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · 2020 · $429,000

## Abstract

Pediatric hydrocephalus affects 400,000 new children annually around the world. The primary etiology in the
developed world is neonatal post-hemorrhagic hydrocephalus (PHH), affecting around 1 in 16 premature
babies born at less than 29 weeks. As cerebrospinal fluid (CSF) builds up in the brain, intracranial pressure
increases and brain development is adversely affected, leading to disability or even death. There is no medical
treatment for PHH and surgical treatments are often impermanent with potentially life-threatening failure.
The development of improved treatment strategies is complicated by the incomplete and evolving
understanding of CSF flow physiology as well as a lack of definitive diagnostics for use in infants. While we
and others have demonstrated the ability to image CSF outflow in rodent models of disease, there has been no
prior approach to image larger, more relevant models. In preliminary studies using custom-built near-infrared
(NIR) fluorescence instrumentation in adult cancer patients and normal volunteers, we have demonstrated the
ability to non-invasively image the deep jugular lymphatic channels that are the predominant drainage
pathways for extracranial CSF flow. Using a similarly sensitive, but non-contrast, fiber-optic, cap-based NIR
tomographic system, we furthermore demonstrated mapping of whole-brain oxygenation in an awake infant
with PHH. Given the enabling technological advances that allowed these measurements, we now expect to
be able to non-invasively map CSF dynamics in infants with PHH following NIR contrast administration into the
CSF.
However, before securing FDA clearance for these studies, we seek to first demonstrate the feasibility for
mapping of CSF dynamics in a closely sized model of pediatric patients under PA-18-623 “Tools to enhance
the study of prenatal and pediatric hydrocephalus.” Specifically, our aims are to non-invasively image
circulatory CSF flow dynamics in cynomolgus macaques following intraventricular and intrathecal
administration of fluorescent contrast as well as develop an understanding of dosing amounts that would be
necessary for subsequent safety and toxicity studies. If successful, this exploratory grant will develop “novel
methods and/or innovative technologies to accelerate the understanding of prenatal and/or pediatric
hydrocephalus,” but to do so in the context of its clinical management. Our translational team consists of
collaborative basic science and clinical investigators who (i) direct surgical management of PHH patients at
Children's Memorial Hermann Hospital; (ii) engineered NIRF lymphatic imaging in over 600 human subjects
under the FDA experience and established NIRF imaging of CSF outflow; and (iii) established the feasibility of
whole-brain NIR tomography in a PHH patient.

## Key facts

- **NIH application ID:** 10108573
- **Project number:** 1R21NS120085-01
- **Recipient organization:** UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
- **Principal Investigator:** Eva M. Sevick
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $429,000
- **Award type:** 1
- **Project period:** 2020-09-30 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10108573

## Citation

> US National Institutes of Health, RePORTER application 10108573, Dynamic Near-Infrared Fluorescence Imaging of CSF Outflow: A Tool to Manage Pediatric Hydrocephalus (1R21NS120085-01). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10108573. Licensed CC0.

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