Applications

Abstract

This chapter will provide a description of the potential applications of liquorpheresis systems and other CSF management systems promoting the clearance of CSF in different pathologies. We will address the rational basis of using these approaches at the time of describing clinical experiences in a number of conditions, including stroke (both ischemic and cerebral hemorrhage and subarachnoid hemorrhage), multiple sclerosis, autoimmune encephalitis, and polyradiculomyelitis, meningeal carcinomatosis and leptomeningeal metastases, infectious diseases including viral encephalitis and viral myelitis, bacterial meningoencephalitis and fungal meningitis and encephalitis; and pathologies related to brain aging such as idiopathic normal pressure hydrocephalus and neurodegenerative diseases.

We will see how, in general, fully implantable systems are better suited for chronic conditions, while extracorporeal techniques are more appropriate for acute conditions. While some of CSF filtration systems have been applied to some cases in humans, few randomized clinical trials have been conducted, and none have shown clear positive results. Therefore, CSF filtration as such cannot be recommended as a standard of care for any condition yet but CSF shunting and CSF drainage are the standard of care in subarachnoid hemorrhage and hydrocephalus, respectively.