Stony Brook Medicine neurosurgeon Michael Egnor announced on April 14 that new research suggests the long-held belief about the cause of hydrocephalus may be incorrect. The study, published in the Journal of Neurosurgery: Pediatrics, proposes that hydrocephalus is caused by a failure to absorb pulsatile energy from the heartbeat rather than an inability to absorb cerebrospinal fluid (CSF).
This finding could change how physicians understand and treat hydrocephalus, a condition affecting about one million Americans and approximately 25 million people worldwide. For decades, treatment has focused on draining excess CSF with shunts, but these devices often malfunction and require repeated surgeries.
“For a century, neurosurgeons and scientists have believed that hydrocephalus is caused by a blockage to CSF absorption that causes a buildup of cerebrospinal fluid in the ventricles of the brain,” said Dr. Egnor, Professor of Neurosurgery and Pediatrics at Stony Brook University. “We showed that the conventional understanding of the cause of hydrocephalus is not correct. Hydrocephalus is caused by the failure of the brain to absorb pulsatile energy from the heartbeat, not by the failure of the brain to absorb CSF.”
The research team used an electrical circuit model to simulate how malabsorption of pulsatile energy could explain features seen in patients with hydrocephalus better than previous models based solely on CSF absorption issues. The authors wrote: “This new understanding of hydrocephalus points to new treatment approaches based on diversion of pulsatile energy.” They further stated: “We propose that hydrocephalus is a disorder of pulsatile dynamics, i.e., hydrocephalus is impairment of the cerebral windkessel system caused by high impedance of pulsatility in the CSF pathways.”
An editorial published alongside their paper supported this approach and encouraged further investigation into treatments targeting CSF pulsatility rather than bulk flow alone. It concluded: “It is time for neurosurgeons to abandon the bulk-flow model… Hopefully we are on the cusp of a new era…” Dr. Egnor said future studies will include imaging work and exploration into new shunt designs.
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