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Originally published December 9, 2025
Last updated December 9, 2025
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Normal pressure hydrocephalus can be difficult to diagnose — and even more difficult to treat. It happens when there’s a backup of cerebrospinal fluid that doesn’t get absorbed well, says Kasra Khatibi, MD, a neurointerventionalist and neurointensivist with the USC Neurological Surgery Program, part of Keck Medicine of USC.
This backup of cerebrospinal fluid causes a triad of symptoms: difficulty walking or gait instability, cognitive issues and urinary incontinence. Since these symptoms overlap with other neurological disorders, normal pressure hydrocephalus can sometimes be overlooked as a diagnosis, he adds.
And even after proper diagnosis, treating normal pressure hydrocephalus can be tricky. “For years, ventriculoperitoneal shunts have been used to treat this disorder,” Khatibi says. In order for these shunts to be placed, patients must undergo invasive surgery. A neurosurgeon has to make a hole in the skull and from the outside direct a catheter into the space between the brain and then track the catheter all the way into the abdomen so that the cerebrospinal fluid can drain properly from the head.
One new treatment modality hopes to go a different route. Keck Medicine is a clinical trial site for the new system, which would be easier to implant than a traditional ventriculoperitoneal shunt because it goes through the blood vessels to enter the space around the brain.
“This is the first technology with which we’re using the vessels of the brain to actually access the space around the brain,” Khatibi says. “The future of this modality is exciting because it could also go both ways. For instance, instead of draining excess cerebrospinal fluid from the brain, we could use this pathway and technology to deliver medications directly into the brain.”
“Normal pressure hydrocephalus is just a very small subset of hydrocephalus patients,” Khatibi says. “Therefore, we could very easily continue to expand the use of this valve and system to other types of hydrocephalus.”
The company developing this technology is also looking at use of the system in children to see if it might be an appropriate treatment for intracranial pressure disorders in youth.
“In Argentina, there has also been some use of this specific technology in treatment of hydrocephalus after subarachnoid hemorrhage,” Khatibi says. “There are many other ways you can help people by draining cerebrospinal fluid outside of normal pressure hydrocephalus.”
Another potential application of this technology is to use it as a way to monitor cerebrospinal fluid more consistently than a spinal tap, he says. “This would be a good way to sample cerebrospinal fluid repeatedly. The apparatus allows you to sample multiple times, and if it can be developed into a two-way valve, you could infuse medications into the space surrounding the brain containing cerebrospinal fluid.”
This could potentially transform care for conditions like coccidioidomycosis, also called valley fever. If the infection extends all the way to the brain, it can require antibiotic treatment to also reach the brain, Khatibi says. “And in order to determine if the treatment is working in the brain, you need to test the cerebrospinal fluid repeatedly,” he says. “This system would give access to that cerebrospinal fluid in a less invasive way than repeated spinal taps.”
The technology has potential for cancer treatment as well, he adds.
“There are a lot of cancers that are being treated through blood vessels in a safe and efficacious way,” Khatibi says. “However, this hasn’t been the case for the brain due to the blood-brain barrier. This type of targeted delivery of medication hasn’t been able to happen in the brain, so treatments for brain cancer have been very limited. The fact that this technology potentially gives us another route to deliver treatment is very promising.”
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