Endovascular Treatment of Hydrocephalus: A Systematic Literature Review

Hydrocephalus is traditionally managed with ventriculoperitoneal shunting (VPS), which is associated with high rates of infection, mechanical failure, and surgical revisions. Recent innovations in endovascular techniques have led to the development of minimally invasive cerebrospinal fluid (CSF) diversion techniques. This literature review systematically examines the development, procedural techniques, efficacy, and safety profile of endovascular treatments for communicating hydrocephalus.

A systematic search was conducted in PubMed/MEDLINE, Embase, Scopus and clinicaltrials.gov from inception until March 15, 2025, following the PRISMA guidelines (PROSPERO registration number: CRD420251012455). Two reviewers independently screened and extracted data. Results are summarized descriptively.

Of 5319 records identified, 16 studies were included. Of those, six were published as original articles and 10 as conference abstracts. Overall, two technical reports of endovascular treatment of hydrocephalus were found: eShunt® (n = 14 studies) and choroidal artery embolization (n = 1 studies). Outcome data are available for 70 patients treated with the eShunt®. In patients with idiopathic normal pressure hydrocephalus treated with eShunt® implantation, the Timed Up and Go test improved by 35.7%, Montreal Cognitive Assessment scores by +1.6 points, and neurogenic bladder symptom scores by -3.6s at one year. No device-related serious adverse events were reported.

Endovascular CSF diversion represents an emerging, minimally invasive alternative to traditional shunting techniques for communicating hydrocephalus. While early results demonstrate technical feasibility and encouraging safety profiles, long-term data from ongoing clinical trials are critical to establish its role in standard neurosurgical and neurointerventional practice.