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A New Treatment for Normal Pressure Hydrocephalus?


Yale Medicine neurosurgeon trials a novel treatment for a rare, age-related condition.

Normal pressure hydrocephalus (NPH)—a rare condition that causes cognitive and physical symptoms—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 available through a Phase 1 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 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 U.S. surgeon 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 the state. 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.

Treating NPH through the blood vessels is a unique approach that can potentially be used for other conditions. For example, Dr. Matouk is starting another study in patients with brain hemorrhages who require a spinal fluid diversion.

“This minimally invasive approach is a potential game-changer in treating normal pressure hydrocephalus,” says Dr. Matouk.