Dr. Salomon Hakim – a Giant in the Field of Hydrocephalus

by Marvin Sussman, Ph.D., HA Board Member and Pip Marks, Director of Support and Education

Respected Colombian neurosurgeon Salomon Hakim, MD, PhD, who worked extensively in the field of hydrocephalus, has died at the age of 88. Dr. Hakim passed away in a Bogota hospital in the early hours of Thursday morning, May 5, due to a cerebral hemorrhage.  Dr. Hakim, whose family name means “doctor” or “wise man” in Arabic, earned his medical degree from the Universidad Nacional in Bogotá and continued his medical education in neurosurgery at Harvard, also earning a Ph. D. in neuropathology.  During his neuropathology fellowship research, Dr. Hakim performed necropsies on patients who died from CNS neurodegenerative conditions such as Alzheimer’s disease.  He noted, in many of the cases, the brain ventricles were enlarged without destruction of the brain cortex.  At that time, nobody was able to explain the reason for this observation.  This led Dr. Hakim to hypothesize that these patients suffered from what he described as Normal-Pressure Hydrocephalus” or NPH after finding a 16-year-old living patient with this condition.

Dr. Hakim’s influence in hydrocephalus has been both long and broad, springing from the active mind of a medical scientist and clinician working at the bedside and in the operating room, laboratory and workshop. Through the recognition and description of an entirely new disorder and the development of complex devices advancing hydrocephalus treatment, he has touched the lives of millions of the young and old stricken with hydrocephalus. Dr. Hakim first described “Normal Pressure Hydrocephalus” in 1964 and initiated the surgery dramatically improving the quality of life in these elderly patients.  Today, in many areas of the world, NPH, a chronic neurological disorder characterized by enlarged ventricles and a triad of clinical symptoms affecting gait, cognition, and urinary continence, is referred to as “Hakim Syndrome” to honor his accomplishments.

His technical genius is evident in the over thirty patents he held.  His designs were not only innovative but also robust, often becoming among the most widely used shunt devices still in use to the present day.  Not satisfied with available hydrocephalus valves, Dr. Hakim invented and developed a number of hydrocephalus valves based upon the spring-loaded, ball-in-cone valve design.  Dr. Hakim improved on existing valve technology which was based upon silicone elastomer slit valves and developed a unidirectional valve with the capacity to regulate the CSF pressure by adding a spring pressure control in a stainless steel cone and synthetic sapphire ball. This valve was introduced to the medical community in Colombia in 1966. It was more reliable and resisted occlusion by protein better than available valves of the time.  Most modern hydrocephalus valves are now built based on this ball-in-cone design. He devised the first shunt system which adjusts drainage with body position and one of the first systems which could be non-invasively adjusted after implantation, as well as one of the initial non-invasively adjustable valves.  These his valve designs and neurosurgical concepts remain cornerstones of modern CSF shunting. His passion for and devotion to helping those with hydrocephalus has spanned over five decades.

The Hydrocephalus Association was honored that Dr. Hakim spoke at its first patient conference on hydrocephalus. Over the years, Dr. Hakim has received numerous honors and awards. In 2010, at the national Hydrocephalus Association conference in Cleveland, Dr. Hakim was awarded the Hydrocephalus Association Lifetime Achievement Award for his lifelong contribution to the understanding and treatment of diseases of the CSF circulation.

Even today, over a half-century after Dr. Hakim’s discovery, NPH sometimes goes unrecognized or is misdiagnosed as Alzheimer’s Disease or other neurodegenerative disorders.  An estimated 9 to 14% of elderly living in assisted living facilities suffer from NPH.  Thanks to Dr. Hakim’s curiosity and perseverance, a field of knowledge was started which led to the clinical management for one of the few dementias that is treatable.  Together with his three sons, a biomedical engineer/scientist and two neurosurgeons, he continued to work on experimental studies of the hydraulics of the cranial cavity and the diseases which afflict it.  His sons will continue his work in the field of NPH.