As a medical device, CSF shunts have a dismal record in relation to failure and infection, despite over 70 years of development. Although endoscopic third ventriculostomy and associated procedures may offer an alternative treatment in some cases, the majority of patients with hydrocephalus are still dependent on shunts. Indeed, for many patients a shunt is a life saving treatment. It is for this reason, and a lack of an alternative effective treatment, that we tolerate such high complication and revision rates. Despite being a necessity, the revision rate remains unacceptable and, akin to other medical devices, the importance of registries and …