The Evolution of Cerebrospinal Fluid Shunts: Advances in Technology and Technique

Abstract

Over the past few centuries, there have been many advances in shunt technology, from the evolution of shunt tubing materials, to advances in valves for regulating the flow of cerebrospinal fluid (CSF). Additional medical advances have enabled the antibiotic impregnation of catheters. Finally, advances in technology have expanded the options for minimally invasive techniques and improved the management of complicated cases of hydrocephalus. The evolution of technology and technique in the management of hydrocephalus with CSF shunts will be discussed here.

Programmable Shunt Valves for Pediatric Hydrocephalus: 22-Year Experience from a Singapore Children’s Hospital

“…These newer valves include locking systems that reduce the risk of unintentional changes to valve setting during MRI scans [ 44 ]. Among the 3 most commonly inserted PSV used by our unit, the CODMAN™ Certas and MIETHKE™ ProGAV shunts are deemed to be MRI-resistant by their manufacturers up to 3 Tesla [ 22 , 23 ]. Without this feature, the concern is that a patient’s PSV opening pressure setting may be adjusted inadvertently post-MRI exposure [ 44 , 45 ].…”

Phase‐Contrast MRI Detection of Ventricular Shunt CSF Flow: Proof of Principle

“…Despite technically advanced VPS systems, the rate of shunt malfunction in the first year after implantation is still over 30% and in up to 80% of all implanted shunts, a malfunction will occur during the patient's lifetime. 7,17,18 The care of patients with shunt-requiring hydrocephalus is, therefore, extremely complex. As there are sometimes very unspecific symptoms of malfunction, such as slight headaches, nausea, and vomiting, the assessment of shunt malfunction is a highly important task for neurosurgeons, especially in cases involving children.…”

“…Despite technically advanced VPS systems, the rate of shunt malfunction in the first year after implantation is still over 30% and in up to 80% of all implanted shunts, a malfunction will occur during the patient's lifetime 7,17,18 . The care of patients with shunt‐requiring hydrocephalus is, therefore, extremely complex.…”

“…In a subset of available systems, that is, Sophysa Polaris and Miethke ProGav, the magnets are arranged in such a way that an accidental change of pressure range is practically impossible up to 3 Tesla (T) magnetic field strength. 6,7 Magnetic resonance imaging (MRI) up to 3 T can be, therefore, safely conducted. Moreover, a recent study suggests that with these valves, smaller artifacts are observed in 3 T MR scanners.…”

“…Where these systems differ from each other in particular is in the technical functionality of the valve, nonprogrammable versus programmable valves, the latter of which are now adjustable by magnetic locking systems. In a subset of available systems, that is, Sophysa Polaris and Miethke ProGav, the magnets are arranged in such a way that an accidental change of pressure range is practically impossible up to 3 Tesla (T) magnetic field strength 6,7 . Magnetic resonance imaging (MRI) up to 3 T can be, therefore, safely conducted.…”