Normal Pressure Hydrocephalus (NPH): New Treatment Shows Promise
Yale Medicine neurosurgeon co-leads clinical trial of a novel procedure.
[Originally published: Jan. 5, 2023. Updated: June 3, 2025.]
Normal pressure hydrocephalus (NPH)—a rare condition that causes cognitive and physical symptoms that are often mistaken for Parkinson’s disease or Alzheimer’s disease—has traditionally been treated with surgery that involves drilling holes in the skull. Surgeons then implant a shunt device and a long tube that snakes to the abdomen, where excess cerebrospinal fluid (CSF) is drained.
Now, a Yale Medicine neurosurgeon is using a minimally invasive technique to treat this condition, which occurs when too much CSF accumulates in the brain, leading to a host of problems, including trouble walking and memory loss. The treatment is currently available through a Phase III clinical trial of an implant called the eShunt System from CereVasc, a medical device company.
With this minimally invasive approach, the eShunt is implanted between a vein in the neck and a CSF pocket at the base of the skull. This allows CSF to drain into the venous system, or the blood, where it is reabsorbed, explains Charles Matouk, MD, chief of Neurovascular Surgery, and the first surgeon in the United States to perform the procedure, which was done at Yale New Haven Hospital.
Furthermore, the implant can be placed in the body through the femoral vein in a patient’s groin. “There’s no head shaving, no hole in the skull. It’s all done through a needle puncture in the groin, which is incredible,” Dr. Matouk says. Because it’s minimally invasive, there is also a reduction in the risk for complications and infection compared with the traditional surgery, he adds.
Dr. Matouk leads Yale Medicine’s Normal Pressure Hydrocephalus Program, which treats the highest volume of NPH cases surgically in Connecticut. When patients come in for NPH treatment, they are screened to see if they are eligible for the eShunt system. “There are rigorous criteria, and they're both clinical and imaging-related,” Dr. Matouk says.
The pilot study for eShunt in NPH had preliminary results that were very encouraging, suggesting the device is safe and feasible for implantation, explains Dr. Matouk. “Yale was the highest enrolling center in the U.S. with 19 eShunt implantations,” he says. “We have the most experience using eShunt in the U.S. by far.”
Yale is now enrolling for the Phase III trial, which is a randomized, controlled study comparing the standard shunt with eShunt. Dr. Matouk is the global co-principal investigator for the study, which is called STRIDE.
“This minimally invasive approach is a potential game-changer in treating normal pressure hydrocephalus,” says Dr. Matouk.
The unique method can potentially be used for other conditions, too.
“For example, there is significant interest in its use of pediatric and hemorrhage-related hydrocephalus, as well as for related conditions like idiopathic intracranial hypertension,” he says.
