New and improved ways to treat hydrocephalus: Pursuit of a smart shunt.
New and improved ways to treat hydrocephalus: Pursuit of a smart shunt.
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DOI：
10.4103/2152-7806.109197
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发表时间：
2013-01-01
影响因子：
--
通讯作者：
Browd, Samuel R
中科院分区：
文献类型：
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作者：
Lutz, Barry R;Venkataraman, Pranav;Browd, Samuel R
脑积水最常见的治疗方法是放置脑脊液分流器以补充或替换失去的引流能力。分流器是挽救生命的设备，但因故障率高、故障诊断困难和控制选择有限而臭名昭著。分流设计自20世纪50年代引入以来几乎没有变化，而且引入的一些变化对这些长期存在的问题几乎没有影响。几十年来，业界一直在设想一种“智能分流器”，它可以基于植入传感器、反馈控制和遥测技术，提供先进的控制、诊断和通信。智能分流器最突出的贡献是先进控制算法的潜力，例如脱离分流器依赖和个性化控制。有了基于传感器的控制，就有机会向医生提供有关患者病情和分流功能的数据，甚至可能通过智能手机。一个经常被忽视但非常有价值的贡献将是设计纠正现有分流的高故障率。尽管有悠久的历史和在过去十年中不断增加的发展活动，患者尚未看到商业化的智能分流。大多数智能分流器的开发都集中在概念上或孤立的技术特征上，但成功的智能分流器设计将在技术可行性、经济可行性和可接受的监管风险之间取得平衡。在这里，我们介绍了这项工作的现状，并提出了一个框架，以了解将引导智能分流器引入患者护理的挑战和机遇。
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.