Explore whether implantable devices and intrathecal delivery approaches can offer meaningful advantages over systemic strategies for CNS targeting, and identify if they are practical, scalable, and still clinically justified

• Identify when device-mediated CNS delivery outperforms systemic or ligand-based approaches
• Debate whether implantation confines this strategy to rare diseases and how engineering and reimbursement innovations could expand use
• Examine key variables that control distribution and reliability including reservoir stability, catheter design, flushing volume, CSF flow, and posture
• Assess trade-offs between device access using minimally modified oligos and complex chemical modification or conjugation strategies