under the skin, down the neck and into the abdominal cavity, where the
excess fluid drains. There were 27,870 shunt-related procedures in 2000.^54
A more recent study estimates 30,000 VP shunt procedures per year, and
this will be used as a 2014 figure.^55
The treatment of a brain aneurysm is either by applying a clip from
outside the vessel via brain surgery, or by floating a tiny coil of tangled
metal through the brain artery. By 2010, this was occurring six procedures
per 100,000 Medicare enrollees,^56 which in that year was 47.7 million
people.^57 That equates to 2,862 Medicare aneurysm treatments in a single
year, but is estimated at 12,000 Americans per year in more recent
literature.^58
Neuromodulation devices target the brain, the spinal cord, or peripheral
nerves. Neurostimulation devices were developed in the 1980s, based upon
cardiac pacemaker-inspired prototypes, and not surprisingly, were first
developed in Minnesota.^59 Implantable devices deliver small amperage
electrical pulses via tiny wires to the brain or to the spinal cord or
peripheral nerves. Implantable drug pumps deliver small molecules to the
central nervous system, allowing for neuromodulation of brain function.
Neuromodulation of brain function is called deep-brain stimulation
(DBS) and is principally used to treat Parkinson’s disease, essential
tremor, and epilepsy. Spinal cord stimulation (SCS) is primarily used to
treat failed back syndrome, chronic regional pain, and peripheral nerve
diseases. Peripheral nerve stimulation (PNS) is used to treat an interesting
combination of diseases, like incontinence, migraines, obesity, obstructive
sleep apnea, and abdominal problems.
DBS was approved by the FDA in 1997 for essential tremor, and in
2002, was indicated for Parkinson’s disease. As with other medical
devices, the FDA allows for case-by-case use under the humanitarian
device exemption (HDE), and with the demonstrated efficacy of DBS for
Parkinson’s disease, the FDA granted exemptions for neurosurgeons to
implant DBS devices for dystonia and obsessive-compulsive disorder.^60
There is a growing list of off-label uses of DBS, including major
depression, Tourette syndrome, anorexia, and even dementia. The most
recent academic paper on the US trend of DBS devices estimated 5,385
implant operations in 2011, and based upon growth trends in the preceding