Liquorpheresis and Related CSF Management Systems: Definitions, Systems, Procedures, and Complications

Abstract

This chapter covers the different mechanical techniques employed for filtering cerebrospinal fluid (CSF), and other CSF management systems that can divert or drain the CSF, thus promoting an indirect replacement of this fluid. Albeit the term liquorpheresis most appropriately designates extracorporeal procedures to filtrate CSF, in parallel to plasmapheresis, this chapter covers any method based on devices that is able to clear the CSF or enhance the turnover, which in turn, results in a dilution of toxins. CSF management systems aiming at diverting CSF will also be described, as they may indirectly promote CSF clearance. After describing the types of procedures and systems, this chapter continues by providing a systematic classification and specific definitions of the different procedures and systems for mechanical filtration of the CSF based on several factors such as the mechanism of action, regime, filter type, implantability, the power required for CSF flow, and the CSF filtrating or neutralizing method. Finally, we will describe the main surgical procedures, the most frequent complications, and will mention the main industry players in the field and briefly describe the regulatory frame.