A267 4 years of clinical & radiological follow up of eShunt + MRI evaluation of flow in adult hydrocephalus

<h3>Introduction</h3> A novel minimally invasive endovascular cerebrospinal fluid (CSF) shunt was developed to mimic the function of the arachnoid granulations <h3>Aim of Study</h3> To evaluate cerebrospinal fluid (CSF) flow through an endovascular device (eShunt) in adult patients with hydrocephalus—either idiopathic normal pressure hydrocephalus (iNPH) or communicating hydrocephalus secondary to subarachnoid hemorrhage (SAH)—using MRI and to compare different imaging strategies, including techniques with and without intrathecal contrast. <h3>Method</h3> A cohort of 42 patients treated with the eShunt device was prospectively studied. Indications included iNPH and post-SAH communicating hydrocephalus. Post-implantation imaging included: (1) intrathecal gadolinium with volumetric T1-weighted sequences, and (2) balanced T2-weighted sequences (bSSFP), leveraging CSF hyperintensity. CT myelography and Doppler ultrasound were also performed in a subset. Two neuroradiologists independently assessed flow visualization, image quality, and patient tolerance. <h3>Results</h3> CSF flow within the eShunt was detected using MRI. Both imaging protocols contributed, with intrathecal contrast-enhanced T1 sequences providing higher sensitivity but mild adverse effects in 3 cases. Balanced T2 imaging showed good diagnostic confidence without the need for contrast. CT myelography and Doppler ultrasound were ineffective in detecting flow within the device. The low detection rate is likely due to intermittent shunt activity at the time of imaging. Importantly, despite imaging inconsistencies, 75% of patients showed clinical improvement following eShunt placement <h3>Conclusion</h3> MRI is the most effective non-invasive modality for evaluating eShunt patency, although real-time flow detection may be limited by physiological variability. Balanced T2 imaging offers a safe alternative, while intrathecal contrast increases sensitivity at the cost of invasiveness. <h3>Conflict of Interest</h3> No