•  Neuroimaging

•  Brain mapping functional MRI, CFD, FEM

•  Spinal dysraphism

•  Craniosynostosis

•  Myelomeningocele

•  Morphometrics

•  Morquio

•  Achondroplasia

•  Spondyloepiphyseal dysplasia

My research interests are in three principle areas:

1. Use of central nervous system imaging technologies to define physiological parameters or relevance to the treatment of children with hydrocephalus
   
   
2. Health care systems development and change, focusing on the development of skills in providers through the analysis of risk and safety during surgical care.
   
   
3. Spinal cord disorders affecting children including spina bifida and occipital-cervical cord compression.

Using CNS imaging technologies to define physiological parameters as they apply to infants and children with hydrocephalus, the directions being taken at the present include the development of techniques to describe the morphological changes in the ventricular system that occur as a result of ventricular shunting or third ventriculostomy. This is based imaging and 3D morphometric analysis. It is also anticipated that MR imaging, using time gated sequences or tensor imaging will allow non-invasive assessments of intracranial compliance. Using such non-invasive measures will assist in the determination of optimal shunting for children with hydrocephalus. This work applies computational fluid dynamic and finite element analysis techniques to biological problems.

Health care programme development, evaluation and service planning are fundamental to the provision of optimal care. Within the discipline of pediatric neurosurgery, the geographical diversity of the western provinces and the limitations imposed by available subspeciality staff and equipment force the evaluation of operative services from the perspecitve of patient care and health economics. Studies have been completed describing the influence of surgeon experience on shunt failure rates in hydrocephalic patients and on the epidemiology of pediatric neurosurgical practice in Western Canada . Similar analyses are applicable to other low frequency, high risk areas such as cardiac surgery.

Improving the quality of care for children with pediatric neurosurgical problems can be approached from the perspective of hypothesis-based studies or by the application of knowledge already known. To apply either effectively, coordinated, structured and focused collaboratives are required. Due to the low frequency and the high risk of conditions treated by pediatric neurosurgeons, a network is being developed to build on the successful Pediatric Neurosurgery Study Group through the application of quality monitoring and improvement techniques.

Spina bifida is the commonest multisystem congenital anomaly seen in humans. The evaluation of interventions is critically important in optimizing patient function and developmental outcomes. Clinical problems studied in this population include the role of elective caesarian section as an attempt to minimize neurological defects and the role of cord untethering as a tool to maximize spinal function in the child. Lipomylemeningocele (lipoma of the conus) patients have been reviewed and the long-term outcome has been quantified and clarified. Programme evaluations have been performed for the benefit of our multidisciplinary clinic and patients .

Compression of the spinal cord by tumours, congenital malformations and bone abnormalities is devastating for patients, as the possibility for permanent paralysis affecting the arms, legs, breathing, bladder, bowel and sexual functions are high. Compression is particularly dangerous when if occurs at the top of the spinal canal. The Departments of Orthopedics and Neurosurgery (Cochrane) have a special interest and expertise in correcting spinal cord and lower brain compression. This special interest involves patients with Morquio's syndrome, achondroplasia and other forms of osteodysplasia.

My current projects include:

• Development of a systematic patient prioritization and scheduling tool
• Children's cancer: access to care - surgical services prioritization
• The determinants of health in children with hydrocephalus

Steinbok P, Heran N, Hicdonmez H, Cochrane DD, Price A. Minimizing blood transfusions in the surgical correction of coronal and metopic craniosynostosis. Child's Nerv Syst 2004: 20:445-452.

Heran N, Steinbok P, Cochrane D. Conservative Neurosurgical Management of Intracranial Epidural Abscesses in Children. Neurosurgery 2003. 553:893-7.

Kestle JR, Drake JM, Cochrane DD, Milner R, Walker ML, Abbott R 3rd, Boop FA; Endoscopic Shunt Insertion Trial participants. Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg. 2003 Feb: 98:284-90.

Cochrane D, Kestle J. The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg 2003: 32:295-301.

Steinbok P, Cochrane DD, Perrin R, Price A. Mutism after Posterior Fossa Tumor Resection in Children: Incomplete Recovery on Long-term Follow-up. Pediatr Neurosurg 2003: 39:179-183.

Cochrane DD, Kestle J. Ventricular Shunting for Hydrocephalus in Children: Patients, Procedures, Surgeons and Institutions in English Canada , 1989-2001. Eur J Pediatr Surg 2002: 12:S6-S11.

Steinbok P, Hentschel S, Almqvist P, Cochrane DD, Poskitt K. Management of optic chiasmatic hypothalamic astrocytomas in children. Canadian Journal of Neurological Sciences 29:132-138, 2002.

Garton HJL, Kestle JRW, Cochrane DD, Steinbok P. A cost effectiveness analysis of endoscopic third ventriculostomy. Neurosurgery. 2002 51:69-77.

Hentschel S, Steinbok P, Cochrane DD, Kestle J. Reduction of transfusion rates in the surgical correction of sagittal synostosis. J Neurosurgery 2002; 97:503-509.

Cochrane DD, Finley C, Kestle J, Steinbok P. The patterns of late deterioration in patients with transitional lipomyelomeningocele. Eur J Surg 2000; 10(Suppl I): 13-17.

Data management committee, International Infant Hydrocephalus Study
Outcome review committee,  Management of Myelomeningocele Study

Canadian Pediatric Neurosurgery Study Group

MFMU Network/MOMS Advisory Board