Implantable devices for chronic access and drug delivery to the central nervous system

This is a review of implantable devices for chronic access and drug delivery to the central nervous system (CNS) via the cerebrospinal fluid, extracellular fluid, and vascular pathways. The current applications of such devices in the management of mycotic meningitis, meningeal leukemia and carcinomatosis, solid malignant tumors of the CNS, intractable cancer-associated pain, unresectable cystic tumors and in cytologic, pharmacologic, and experimental studies on the cerebrospinal fluid (CSF) are assessed. Specific attention is paid to the applications of the most commonly used device, a subcutaneous reservoir and pump (SRP), including its major uses and complications. A new system for local chemotherapy of malignant gliomas, the tumor cyst device (TCD), is also described.