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Cerebrospinal fluid disorders and shunts: it’s time to move forward. Invited commentary on 'First-in-human endovascular treatment of hydrocephalus with a miniature biomimetic trans-dural shunt'
  1. Kyle M Fargen1,
  2. Daniel E Couture2
  1. 1Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
  2. 2Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Kyle M Fargen, Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, NC 27109, USA; kfargen{at}wakehealth.edu

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We read with great excitement the report by Lylyk and colleagues describing the first in-human use of a trans-dural shunt implanted via a transvenous approach for hydrocephalus.1 In their published case report, an octogenarian with communicating hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) was successfully treated with the eShunt. The novel eShunt device utilizes a retrievable stent in the inferior petrosal sinus that serves as an anchor and allows for trans-dural penetration and then implantation of a small shunt catheter into the cerebellopontine angle via a transvenous catheter. The tail of the shunt catheter extends into the jugular vein, allowing unimpeded cerebrospinal fluid (CSF) drainage directly from the cistern into the jugular venous system. There is a unidirectional valve preventing reflux of venous blood through the tubing. In the presented case, intracranial pressures were monitored and normalized over the ensuing days, and brain imaging roughly 1 week later showed decreased ventricular size.

CSF shunts have plagued neurosurgeons and their patients for years. Shunts have served as the standard of care treatment for patients with varieties of obstructive and communicating hydrocephalus (congenital, post-hemorrhagic, post-infectious, and oncologic), normal pressure hydrocephalus (NPH), and for those with visual loss in idiopathic intracranial hypertension (IIH), yet failure rates remain considerable. In infants and young children, shunt malfunction rates approximate 50% at 2 years and this has remained unchanged over the last two decades.2 3 Infections and other procedural complications are very common.4 In adult patients with communicating hydrocephalus after aneurysmal SAH, shunt complications occur in about 20% of patients5 and revision surgeries are necessary in around 30% of patients.6 In patients with NPH, ventriculo-peritoneal shunt complications occur in 13%–38% of patients and malfunction occurs in 15% of patients in the first year after surgery.7 Patients with IIH have shunt failure …

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Footnotes

  • Contributors Concept and design: KMF. Drafting the article: both authors. Final approval: both authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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