Closed-loop control of intracranial pressure

Rekate, Harold L.

doi:10.1007/bf02363450

Cited by 15 publications

(3 citation statements)

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“…As early as 1980, Rekate published rationale for a closed-loop control of CSF drainage[64] and by 1988, Rekate and colleagues published a remarkably complete proposal for a smart shunt design. [46] The description covered key aspects of CSF regulation based on flow control with safety overrides, two-way communications, physician's role in adjustments, hardware and electrical designs, device size and implant location, and device packaging.…”

Section: Introductionmentioning

confidence: 99%

“…There has been vigorous debate in the literature over advanced control strategies that aim to recreate conditions of the intact CSF system. [64] In addition, many researchers have emphasized shunt weaning (progressive withdrawal of shunt dependency) as a key potential contribution of smart shunts. [34658] The Al-Nuaimy group has described concepts for advanced controls that vary with time of day and patient feedback, and they have suggested modeling as an integral part of predictive and adaptive algorithms for personalized control.…”

Section: Introductionmentioning

confidence: 99%

“…Shunt valve obstruction is responsible for 30% of shunt failures,[16172123284164] thus reducing valve obstruction is one of the greatest areas of potential impact. A great deal of work has focused on material modifications, especially of the proximal catheter, to reduce obstruction by cells or tissue; these methods have high value and have been reviewed recently by Harris et al .…”

Section: Introductionmentioning

confidence: 99%

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New and improved ways to treat hydrocephalus: Pursuit of a smart shunt

2013

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The most common treatment for hydrocephalus is placement of a cerebrospinal fluid shunt to supplement or replace lost drainage capacity. Shunts are life-saving devices but are notorious for high failure rates, difficulty of diagnosing failure, and limited control options. Shunt designs have changed little since their introduction in 1950s, and the few changes introduced have had little to no impact on these long-standing problems. For decades, the community has envisioned a “smart shunt” that could provide advanced control, diagnostics, and communication based on implanted sensors, feedback control, and telemetry. The most emphasized contribution of smart shunts is the potential for advanced control algorithms, such as weaning from shunt dependency and personalized control. With sensor-based control comes the opportunity to provide data to the physician on patient condition and shunt function, perhaps even by a smart phone. An often ignored but highly valuable contribution would be designs that correct the high failure rates of existing shunts. Despite the long history and increasing development activity in the past decade, patients are yet to see a commercialized smart shunt. Most smart shunt development focuses on concepts or on isolated technical features, but successful smart shunt designs will be a balance between technical feasibility, economic viability, and acceptable regulatory risk. Here, we present the status of this effort and a framework for understanding the challenges and opportunities that will guide introduction of smart shunts into patient care.

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Section: Introductionmentioning

confidence: 99%