Cerebrospinal Fluid Shunts: An Updated Radiologic Review of Devices, Malfunctions, and Complications

Cerebrospinal fluid (CSF) shunt devices are essential for managing hydrocephalus by diverting excess CSF from the ventricles and thereby reducing symptoms such as headaches, vision problems, and cognitive deficits. A typical shunt system includes a ventricular catheter, reservoir, valve, and distal catheter. These components are usually made of silastic and radiopaque materials for durability and imaging. The systems also include enhancements like programmable valves, anti-siphon devices, and gravitational units to improve function. Shunts are categorized by outflow destination (ventriculoperitoneal, ventriculoatrial, ventriculopleural, and lumboperitoneal) or by valve type (fixed or adjustable). While fixed valves have been the standard of care for years, adjustable valves allow non-invasive pressure changes, reducing the need for repeated surgeries. Radiographic evaluation of shunt placement and function is crucial in clinical care. Common complications associated with the use of such systems include mechanical failure (e.g., obstruction, fracture, and migration), infections, functional issues, and metastasis, which often require surgical revision. This paper offers an overview of CSF shunts, including their structure, functions, imaging characteristics, and potential complications. Additionally, we have summarized the imaging characteristics of currently available programmable shunt devices and briefly discussed other types of commonly used drainage devices along with their specific indications. A thorough understanding of these aspects is critical for effective diagnosis, treatment, and management of hydrocephalus and its related challenges.