Current state of smart shunt technology-a future dream or tangible perspective: a systematic review

Hydrocephalus, a condition characterized by disrupted cerebrospinal fluid (CSF) dynamics, has historically and mainly relied on ventriculoperitoneal shunt (VPS) systems for treatment. Despite considerable advances in the field, ranging from early valve-less systems to adjustable pressure valves and anti-hydrostatic devices, shunt failure rates remain high, and optimal, individualized CSF drainage remains challenging to achieve. Since hardly any objective feedback measures of shunt function are integrated in the shunt system in order to achieve physiologic like CSF drainage, it somehow remains to be a black box. In response to the aforementioned challenge, the concept of a "smart shunt" has emerged, with the objective of establishing a self-regulating system. The objective of this systematic literature review is twofold: firstly, to analyze existing research on smart shunts; secondly, to synthesize this research in order to highlight any advancements. In order to achieve these objectives, a systematic literature review was conducted in accordance with the PRISMA guidelines, yielding a total of 135 potentially relevant articles. Following the elimination of duplicates and a more thorough evaluation, 22 articles were deemed pertinent for additional scrutiny. Furthermore, a patent search was conducted, which identified ten relevant results. While technological advances render the realization of a smart shunt increasingly feasible, financial challenges remain and further interdisciplinary research and clinical validation are essential to translate this concept into a reliable, personalized treatment option for patients with hydrocephalus.