A new minimally invasive treatment for normal pressure hydrocephalus

Normal pressure hydrocephalus (NPH) is a condition characterised by cognitive and physical symptoms which develop insidiously over time. The symptoms include difficulty walking, dementia, and urinary incontinence. The symptoms are probably in part caused by compression of the brain from enlargement of its fluid-filled ventricles. NPH typically affects older people and is progressive but can often respond well to treatment. It is one of the few causes of dementia that can be slowed or even reversed with treatment. NPH is usually treated with surgical placement of a shunt to drain the excess cerebrospinal fluid (CFS) from the brain into the abdomen.

Neurosurgeons at medical centres in Yale and Boston, are using a new, minimally invasive technique to treat NPH. The Phase 1 clinical trial has strict selection criteria and uses an implant called the eShunt System from CereVasc. The eShunt is implanted between the base of the skull and a neck vein, allowing CSF to drain into blood vessels where it can be reabsorbed.

The eShunt can be placed in the body without needing to drill into the skull, as it is placed via a needle puncture to the femoral vein in the groin. Because the approach is less invasive, it should reduce the risk of complications compared with traditional shunt surgery. Preliminary results suggest the eShunt can be safely implanted and lead to rapid and significant functional improvements for the patients. “This minimally invasive approach is a potential game-changer” says Dr Matouk, one of the neurosurgeons involved in the trial. 

Treating NPH via blood vessels is a novel technique that may have potential for treating other conditions. Dr Matouk has already started another study using the eShunt system to divert CSF in patients with brain haemorrhages. It will be some time before enough evidence can be gathered to support the approach becoming the gold-standard treatment but the research is off to a promising start.