The CSF accumulator: its role in the central nervous system and implications for advancing hydrocephalus shunt technology.

The 'cerebrospinal fluid (CSF) accumulator' plays an important physiological role in the healthy central nervous system as both a shock absorber and regulator of drainage. In the presence of hydrocephalus, this function is compromised by resistance to the flow of CSF. It is further compromised by the placement of a standard shunt which allows only for one-way directional diversion of the fluid. Complications associated with shunt dependency may be a direct consequence of both the condition, and a failure of existing systems to restore the normal accumulator function. This article reviews the pathophysiology of the 'CSF accumulator' as it relates to hydrocephalus and its management, and proposes a biomimetic shunt designed to restore the 'CSF accumulator' toward normal. It is hoped that such a device will support normalization of intracranial pressure and restore an appropriate level of CSF volume in the shunted patient.