Newswise — DENVER (April 12, 2011) − On December 5, 1960, 4-month-old Theo Dahl, the only son of best-selling author Roald Dahl and actress Patricia Neal, suffered a shattered skull in a horrific traffic accident involving his pram in New York City. As a result of his head injury, Theo developed secondary hydrocephalus. Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. A head injury can damage the brain’s tissues, nerves, or blood vessels. Blood from ruptured vessels can enter the CSF pathway, causing inflammation. Sites of CSF absorption become blocked by scarred membranes or blood cells, causing CSF flow to become restricted, which can lead to hydrocephalus.
Theo required an oxygen tent for two weeks and underwent several operations to drain fluid from his brain. He appeared well enough for the family to return to London just before Christmas. Unfortunately, his condition deteriorated due to the hydrocephalus, which was pressing on his brain and causing blindness.
Although Theo had a shunt inserted, this technology was in its infancy 50 years ago and prone to malfunctioning, causing the CSF to become obstructed. During the course of nine months, he needed six shunt revisions, as his condition improved and deteriorated repeatedly. "What began as a personal tragedy for the family would soon evolve into an elaborate crusade by Roald Dahl to expound upon pre-existing valve technology with the goal of developing a shunt that simply would not obstruct. Ironically, by the time the valve was ready for patient use, Theo’s case of hydrocephalus had resolved,” said lead author Adam L. Sandler, MD, a neurosurgical resident at Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, N.Y.
Dr. Sandler will present the details of this fascinating topic, Marvelous Medicine: The Untold Story of the Wade-Dahl-Till (WDT) Valve, 4:33-4:45 pm, Tuesday, April 12, during the 79th Annual Scientific Meeting of the American Association of Neurological Surgeons in Denver. Dr. Sandler collaborated on this research with Donald Sturrock, who wrote the first authorized Roahl Dahl biography, Storyteller: The Life of Roald Dahl, published in September 2010.
Based upon exclusive access to private archives of the Dahl estate and The Roald Dahl Museum and Story Centre, as well as interviews with relatives of those involved, this manuscript tells the intricate tale of one famous father’s dogged drive to significantly alter the natural history of pediatric hydrocephalus. Among the issues the authors examine:
•Dahl’s role in facilitating the collaboration among neurosurgical giants Joseph Ransohoff, MD, and Kenneth Schulman, MD, who were affiliated with the New York University School of Medicine in 1960, and Kenneth Till, MD, who was the first pediatric neurosurgeon in the United Kingdom. The process to develop this valve required years of research conducted by these three leading pediatric neurosurgeons of the era. Dahl paid for Dr. Till to travel to New York and meet his American counterparts and Dr. Ransohoff visited Dr. Till in England.
•There were many revisions to the shunt and difficulty in its manufacture, specifically related to obtaining the requisite tubing and a suitable method of sterilization.
•The ensuing rift between the American and British neurosurgical contingents that nearly sidelined the project. The archives hint at a major falling out between the American and British groups and that Dahl’s often irascible personality may have played a part.
•Correspondence between Dahl, British toymaker Stanley Wade, and Dr. Till reveal that Dahl wished to make this shunt available to all hydrocephalic children, especially those in Africa and India, to be partially subsidized by a slight price mark-up in the UK and United States. The three men created The Children’s Research Fund at the Hospital for Sick Children, Great Ormond Street, England, thereby insuring that the patent rights for the shunt were held by a non-profit organization devoted solely to medical research.
•Word of the tragedy that befell young Theo spread far and wide. Dahl received letters from parents around the world and he often wrote back to them with words of inspiration and hope. In these letters, Dahl displays a profound knowledge of the pathophysiology of hydrocephalus. He was actively involved in support groups dealing with pediatric brain injury in the UK and abroad. Dahl’s Marvelous Children’s Charity currently funds pediatric nurses specializing in the care of children with acquired brain injury.
“The development of the WDT valve marked a significant turning point in the surgical management of pediatric hydrocephalus in general and in shunt valve technology. Dahl’s role in this advancement and his in-depth knowledge of this facet of neurosurgery is truly remarkable and historically important,” said Dr. Sandler.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 8,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.
Disclosure: the author reports no conflicts of interest.
Media Representatives: If you would like to cover the meeting or interview a neurosurgeon − either on-site or via telephone − please contact the AANS Communications Department at (847) 378-0517 or call the Annual Meeting Press Room beginning Monday, April 11 at (303) 228-8431.
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