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Joshua Medow, MD, a neurosurgeon and director of UW Health's Neurocritical Care Program saw a problem and took steps to fix it.


With the help of colleagues in Neurosurgery and the University of Wisconsin's School of Biomedical Engineering, a new implantable cranial pressure monitor has now entered a critical phase of testing and development. This is great news for hydrocephalus patients and their families. The progress from concept to testable product, however, is a remarkable story in itself.


First, the problem.


Ten years ago, Dr. Medow saw that hydrocephalus patients with headaches had an issue. If the pain was the result of a failing or malfunctioning shunt, the possible repercussions were very serious including brain or other physiological damage. In these cases, timing was critical and surgery likely. Advance warning of such conditions would be a huge advantage for a favorable outcome.


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On the other hand, the pain may be no more than a normal headache and there wasn't an easy, non-invasive way to tell the difference. Even in the best situations, it was possible that surgery would be necessary to be completely sure all was well with cranial pressure and the shunt's operation. This also meant that the family may have been put into a position where they needed to take time away from work and to undergo financial hardships.


It seemed to Dr. Medow that a better solution was needed that would show the difference between the truly high acuity situations needing immediate attention and those where minimal intervention was needed. In addition, his theory was to keep costs down by developing an inexpensive implantable sensor while keeping the costly electronics in an outside reader device. This reader would then communicate remotely to a smart phone or computer for diagnosis and devising of a treatment plan.


How to start such a project was the question. For Dr. Medow, the answer was to begin simply by using his background in engineering and computer science to test his theories.


Dr. Joshua Medow explains the prototype of his intracranial pressure monitor.

While he was neurosurgery chief resident at UW Hospital and Clinics, Dr. Medow began to create the schematic for the product then using his own money to buy parts from Radio Shack to build a crude prototype. Over the next few years, with additional support from the neurosurgery department and the UW School of Engineering, the solution began to take shape. There was now a "proof of concept" but more help would be needed to move the product into the miniaturization and testing phase. In 2011, this help arrived.


The Hartwell Foundation looks to fund projects that have high potential for helping patients in new ways particularly children. They also look for ideas that are on the cutting edge but are at risk of never being completed without financial backing. With only a few selected each year, the competition for funding is intense but they liked what they saw from Dr. Medow's Implantable Cranial Pressure (ICP) Monitor and awarded the project a $300,000 grant this year.


Graduate engineering students have taken the concepts and built a tiny implantable device that is actually made on campus in a "clean room" designed to minimize any dust particles during production. The reader device is in prototype phase and a working model is expected to be ready in a few months.


Dr. Medow was selected to receive the 2011 Rising Star Clinical Excellence award from UW Hospital and Clinics and a 2010 Clinical Teaching Award presented by fourth-year students at the UW School of Medicine and Public Health. He has also established the UW Health's Neurocritical Care program and shown how to improve outcomes with efficient processes. At the heart of all his accomplishments, though, is a passion for finding better ways to help patients.


"One of the advantages of working in a combined clinical and academic setting is the collaboration available for projects like this," said Dr. Medow. "Even though we have many more steps in the development process ahead, I am confident that a solution will emerge that will make a huge difference in how we treat cranial pressure issues. Having the right team working together is key to this success."