Endovascularly Implantable Cerebrospinal Fluid Shunt: Can We Simplify Communicating Hydrocephalus Treatment?

Purpose: To do an educational review of the eShunt system and the novel ETCHES I Study (Endovascular Treatment of Communicating Hydrocephalus With an Endovascular Shunt)

Materials and Methods: The first in-human trial on endovascular treatment of communicating hydrocephalus is underway. The ETCHES I is a single-center prospective pilot study. The first successful percutaneous implantation of the eSHUNT system using a catheter-based endovascular approach was recently described.¹ We review the approach, benefits, and future outlook of this novel system.

Results: Why do we need a shift from conventional ventriculoperitoneal shunt (VPS) systems? VPS surgery is presently the most common approach for the treatment of communicating hydrocephalus. However, postoperative complications are common, with a high rate of central nervous system infections and VPS revisions—21.3 complications per 100 patients per year in the first year after VPS surgery.² This summons an innovation in the currently accepted approach for treatment of patients with communicating hydrocephalus. The ETCHES I study has been designed to study the outcomes and potential reduction in complications from VPS surgery. The eSHUNT system being used is percutaneously deployed in the cerebellopontine angle cistern under fluoroscopy guidance and works by mimicking the function of arachnoid granulations in allowing the drainage of CSF from the arachnoid space to the venous system. Results from the first in-human experience have been recently published and demonstrate reduction in intracranial pressure levels after the endovascular treatment. This positive outcome could signal a revolution in the treatment of patients with communicating hydrocephalus.

Conclusions: Percutaneous endovascular treatment could reduce the need for invasive surgery and rates of postoperative complications. Outcomes from the first described case have been positive; however, we look forward to complete dataset from the ETCHES I trial.

References:

1. Lylyk P, Lylyk I, Bleise C, et al. First-in-human endovascular treatment of hydrocephalus with a miniature biomimetic transdural shunt. J Neurointerv Surg 2021 Dec 3:neurintsurg-2021-018136. doi: 10.1136/neurintsurg-2021-018136. Epub ahead of print.

2. Merkler AE, Ch’ang J, Parker WE, et al. The rate of complications after ventriculoperitoneal shunt surgery. World Neurosurg 2017;98:654-658.