The vision of our team is to realize the first self-aware hydrocephalus shunt to enable treatment based on a quantitative measurement of shunt performance using implanted sensors. Hydrocephalus has stubbornly remained a major neurosurgical challenge despite decades of development of ventriculoperitoneal shunts. Treatment costs exceed $2B annually, with a significant portion of that cost associated with the high failure rates of shunts. Shunt malfunction rates are estimated at 40% in the first year to 85% in ten years of use. Even so, there have been only modest advancements in shunts since their introduction in the 1950s. Their primary function is to regulate intracranial pressure via controlled drainage of excess cerebrospinal fluid from the ventricles to elsewhere in the body where it can be safely reabsorbed. Failure is caused by obstruction, improper drainage, and disconnects. Current diagnosis of shunt malfunction is imprecise and involves neuroimaging studies and shunt tapping, an invasive measurement of intracranial pressure and shunt patency. While hydrocephalus is incurable, shunt failure is very treatable by revision or replacement. The lack of non-invasive, cost-effective methods to accurately diagnose shunt failure in a timely manner means that patients must live in constant fear that each headache signals potential shunt failure. This proposal addresses these shortcomings using implantable sensors designed to operate in-line with a shunt that provides definitive, actionable data to clinicians. The potential impact is improved treatment along with decreased healthcare utilization and costs.