Neurology · Medical Literature
Telemetric sensors for intracranial pressure monitoring in children with CSF shunts: a systematic review and narrative synthesis.
Abstract
Telemetric sensors are optionally inserted for intracranial pressure monitoring in paediatric hydrocephalus management. Children with shunted hydrocephalus may undergo multiple surgeries to investigate shunt function throughout their childhood. Understanding whether telemetric sensor use in the paediatric population improves surgical outcomes and has an economic benefit is vital. A systematic review was performed utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles included were from the OVID Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database. Reports from 1st September 2000 to 31st August 2025 for patients under 18 years old with hydrocephalus were included. From 1190 studies identified, 7 were included in the systematic review. A narrative synthesis was feasible, however due to the limited number of heterogeneous articles, a quantitative meta-analysis was not possible. Five overarching themes which support telemetric sensor implementation were identified. These include (i) evidence of technical feasibility and reliability of ICP measurements, (ii) no identified significant safety concerns, (iii) meaningful valve adjustment data, (iv) the benefit of objective ICP readings over symptom-driven ICP management, and (v) evidence that telemetric sensors and appropriate protocols facilitate outpatient management. Implementing the use of telemetric sensors in the paediatric population is safe, technically feasible, clinically informative, and potentially valuable in some paediatric patients with shunted hydrocephalus.
Clinical relevance
Pediatric hydrocephalus managed with CSF shunts carries significant surgical burden, as children frequently undergo repeat interventions to evaluate shunt function throughout childhood. This systematic review addresses a critical evidence gap regarding the safety, reliability, and clinical utility of telemetric intracranial pressure (ICP) sensors as adjuncts to conventional shunt management in patients under 18 years. Given the morbidity associated with repeated neurosurgical procedures in this population, objective non-invasive ICP monitoring strategies warrant rigorous appraisal by pediatric neurosurgeons and neurologists.
Key findings
1. From 1,190 studies initially identified via OVID Medline, EMBASE, CENTRAL, and Cochrane Database (2000–2025), only 7 met inclusion criteria, underscoring the marked paucity of high-quality evidence in this domain; quantitative meta-analysis was not feasible due to study heterogeneity. 2. Telemetric ICP sensors demonstrated technical feasibility and measurement reliability across included studies, supporting their use as a technically viable adjunct in pediatric shunt management. 3. No significant safety concerns were identified across the reviewed studies in the pediatric population, suggesting an acceptable short-term safety profile for sensor implantation. 4. Sensors provided clinically meaningful valve adjustment data, indicating that telemetric ICP readings directly informed programmable shunt valve titration decisions beyond what symptom assessment alone could offer. 5. Objective ICP readings were shown to be superior to symptom-driven management strategies, with telemetric data identifying ICP abnormalities in patients who were clinically asymptomatic or whose symptoms were non-specific. 6. Implementation of telemetric sensors, combined with appropriate institutional protocols, was associated with facilitation of outpatient ICP management, with potential implications for reducing inpatient admissions and operative interventions; however, formal health-economic quantification was not reported in the included studies.
Practice implications
Pediatric neurosurgeons should consider telemetric ICP sensor insertion at the time of shunt placement or revision in selected patients — particularly those with complex or recurrent shunt dysfunction, unreliable symptom reporting, or programmable valves requiring serial pressure optimization — as the technology appears safe and clinically informative based on current evidence. Institutions adopting this technology should develop structured outpatient ICP monitoring protocols to capitalize on the demonstrated potential for reducing unnecessary surgical explorations and inpatient admissions. Given that only 7 heterogeneous studies were available and formal cost-effectiveness data are absent, prospective comparative trials with standardized outcome measures and health-economic endpoints are urgently needed before universal adoption can be recommended.