Advances in CSF shunt devices and their assessment for the treatment of hydrocephalus

ABSTRACT

Introduction

Hydrocephalus is a neurological disorder caused by excessive accumulation of the cerebrospinal fluid (CSF) in the ventricles of the brain. It can be treated by diverting the extra fluid to different parts of the body using a device called a shunt. This paper reviews different shunt devices that are used for this purpose.

Areas covered

Shunts have high failure rates either due to infection or mechanical failure, therefore there is still ongoing work to address these two main handicaps. They require additional devices for performance assessment. Here, the paper also reviews different approaches for assessing shunt limitations. Moreover, future prospects are also discussed.

Expert opinion

This study shows that shunt devices still remain an important treatment option for hydrocephalus. However, further efforts are required to design more advanced shunts, to eliminate high failure rates in clinical use. Sophisticated sensor systems that can accurately detect and regulate changes in CSF drainage to optimize drainage for individual needs. Moreover, shunt infection problem is still present despite recent improvements such as antibiotic impregnated catheters.

KEYWORDS:

• Anti-siphon
• hydrocephalus
• over-drainage
• shunt
• valve

Article highlights

• CSF shunt devices are widely used for the treatment of hydrocephalus.

• Anti-siphoning devices are often integrated with shunts, to regulate drainage of the CSF.

• Shunt devices have high failure rates and therefore more efforts are required towards the design, materials, and control algorithms.

• More advanced shunt devices that can keep track of key parameters, such as, ICP, flow rates, pressure gradients, and alert as soon as they become critical are required.

• Enhanced biocompatible materials and novel techniques should be used in the production of shunt devices, to minimize the risk of shunt infections.

Declaration of interest

The author(s) have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One peer reviewer has consulted for the ReFlow device produced by Anuncia. Another peer reviewer is the inventor of an antimicrobial shunt catheter and has received speaker fees paid to his university from a manufacturer of antimicrobial shunt catheters. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.