Key takeaways:
- Regular stress hydrocephalus is a reversible situation of dementia that primarily impacts older adults.
- The eShunt System goals to supply a minimally invasive answer to open mind surgical procedure.
Regular stress hydrocephalus, a situation wherein cerebrospinal fluid builds up within the mind, can result in points corresponding to cognitive impairment, problem strolling and bladder dysfunction.
An estimated 800,000 people in the USA, primarily aged older than 65 years, take care of regular stress hydrocephalus. A new gadget that’s much less invasive than surgical procedure might be able to assist sufferers with the situation.
Healio spoke with Ricardo Hanel, MD, PhD, a neurosurgeon at Baptist Well being in Jacksonville, Florida, to study in regards to the novel, minimally invasive eShunt System from CereVasc, which can enhance security, entry and general quality-of-life issues for sufferers with NPH and in regards to the pending medical trial investigating its efficacy.
Healio: What was the impetus for the creation of the STRIDE examine? What do you hope to perform with its completion?
Hanel: Regular stress hydrocephalus (NPH) is characterised by three major progressive signs: gait disturbance, urinary incontinence and cognitive decline. Whereas a few of these signs are largely reversible, particularly when therapy is rendered early in the midst of the illness, about 80% of affected sufferers go undiagnosed.
Even sufferers who know they’ve NPH will not be eligible for the present customary of therapy, which includes a surgical process known as a ventriculo-peritoneal (VP) shunt placement. Elements corresponding to age, frailty or comorbidities could stop sufferers from receiving surgical procedure.
Baptist Well being, together with greater than 20 different trial website places, is trying to develop out there therapy choices by way of its participation within the STRIDE medical trial to judge the eShunt System, a novel, investigational, minimally invasive different, in opposition to the VP shunt, as we speak’s main surgical therapy for NPH.
The hope is to enhance affected person outcomes by making therapy accessible and secure for extra sufferers, significantly those that should not candidates for open-brain surgical procedure.
NPH is a reversible reason behind dementia, and we’re very excited on the prospect of enhancing alternatives for this affected person inhabitants.
Healio: How can clinicians successfully handle the diagnostic hole seen with regular stress hydrocephalus?
Hanel: Diagnosing NPH will be tough as a result of it might mimic different ailments, corresponding to Alzheimer’s and Parkinson’s.
Physicians could make a stable differential analysis by first recognizing signs that could possibly be related to NPH and assessing these signs. A excessive index of suspicion is essential. If the affected person demonstrates gait impairment related to short-term reminiscence points, the doctor could recommend a lumbar puncture to empty extra cerebrospinal fluid (CSF) after which re-administer the take a look at to disclose whether or not the affected person’s mobility has improved, serving to to confirm NPH. A key signal to look out for is usually a individual’s ft showing to be caught or glued to the bottom.
Physicians must also order a CT scan or MRI to find out if extra CSF is current and demonstrating ventricular enlargement. Though not particular to NPH, sure MRI indicators could help the analysis.
Whereas these checks will assist physicians extra precisely diagnose NPH, it’s vital for caregivers and family members to be looking out for these signs at dwelling as properly and bear in mind that they could be attributable to greater than the everyday results of growing old.
Healio: What differentiates the eShunt System from present drainage strategies and the way do you anticipate the gadget to have an effect on the NPH customary of care?
Hanel: To implant the VP shunt, a catheter is handed by way of a burr gap drilled into the cranium, into the cavity contained in the mind known as a ventricle, the place the pool of gathered CSF is current. Subsequent, that catheter is related to an extended catheter that’s then handed throughout the collarbone and into the stomach. These two catheters are related by way of a programmable valve that permits extra CSF to empty from the ventricle into the peritoneal cavity.
This new minimally invasive methodology doesn’t require a scalp incision or burr gap, nor does it want a catheter in direction of the stomach or valve. As an alternative, a brief supply system is launched into the femoral vein by way of a small needle within the groin and fed to the bottom of the mind. There, earlier than eradicating the supply system, a small catheter is implanted that can stay in place to empty CSF into the venous system to be reabsorbed by the physique. This carefully follows the method for the way CSF would drain in a wholesome particular person.
As a result of an endovascular method is much less invasive than conventional open surgical procedure, it may probably supply sure benefits for sufferers, corresponding to fewer issues, diminished hospital stays and fewer follow-up visits or interventions.
If the brand new method exhibits promising ends in the STRIDE examine, because it demonstrated in preliminary research, our hope is that extra therapy choices will likely be out there to extra sufferers.
Healio: How may the eShunt present higher entry to take care of the situation?
Hanel: The hope is that it’s going to present higher entry to care by increasing therapy choices and decreasing issues. With improved security, extra sufferers will likely be amenable to therapy. Age is a consideration when considering any open surgical procedure. Aged sufferers tolerate minimally invasive endovascular procedures higher than conventional open neurosurgeries, so having the ability to supply this therapy means we may probably serve a a lot bigger proportion of sufferers with NPH.
In addition to avoiding a number of the dangers related to conventional mind surgical procedure, sufferers can proceed taking medicines corresponding to blood thinners to handle present cardiovascular situations.
Healio: Are you able to handle how extra environment friendly shunting would have an effect on sufferers’ general high quality of life?
Hanel: Offering our sufferers a greater high quality of life is one in all our highest priorities. We anticipate this new shunt to have related efficacy in contrast with the VP shunt, reversing the signs of NPH in lots of sufferers however with fewer issues. It additionally has the potential to require much less intervention from physicians after surgical procedure. A decrease complication fee will result in extra versatile indications for the process, resulting in extra sufferers receiving therapy.
Sufferers who’ve obtained the VP shunt generally expertise over drainage of fluid once they change their physique positions rapidly, and docs should resolve that drawback by readjusting the shunt with a magnet. Over drainage can result in mind bleed with lack of advantage of CSF drainage.
As a result of this new sort of shunt is designed to self-adjust as sufferers transfer, the hope is that it’s going to trigger much less disruption in a affected person’s each day life and enhance their high quality of life and probably end result within the want for fewer journeys to the physician.
Reference:
CereVasc, Inc. proclaims outcomes of groundbreaking medical examine of the eShunt System within the therapy of aged sufferers with regular stress hydrocephalus. https://www.prnewswire.com/news-releases/cerevasc-inc-announces-results-of-groundbreaking-clinical-study-of-the-eshunt-system-in-the-treatment-of-elderly-patients-with-normal-pressure-hydrocephalus-302368231.html. Revealed Feb. 5, 2025. Accessed April 30, 2025.
CSF Overdrainage. https://radiopaedia.org/articles/csf-overdrainage?lang=us. Revised July 15, 2024. Accessed April 23, 2025.
Endovascular Mind Surgical procedure. https://www.yalemedicine.org/situations/endovascular-brain-surgery-accessing-your-brain-through-blood-vessels. Accessed March 7, 2025.
Hydrocephalus Affiliation. Regular Stress Hydrocephalus (NPH) vs. Alzheimer’s and Parkinson’s. Copyright 2025. Accessed March 7, 2025. https://www.hydroassoc.org/nph-vs-alzheimers-parkinsons/.
Ventriculo-peritoneal shunt. https://brainbookcharity.org/ventriculo-peritoneal-shunt/. Revealed March 30, 2020. Accessed March 7, 2025.
For extra data:
Ricardo Hanel, MD, PhD, will be reached at neurology@healio.com. He will be discovered on Fb and Instagram at: @BaptistHealthJx.
