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Prashant Chittiboina, Helena Pasieka, Ashish Sonig, Papireddy Bollam, Christina Notarianni, Brian K. Willis and Anil Nanda

underwent revision surgery did not differ significantly from those who did not undergo revision surgery with respect to sex (p = 0.44), communicating vs noncommunicating hydrocephalus (p = 0.56), type of catheter (antibiotic impregnated vs non–antibiotic impregnated, p = 0.54), grade of IVH (p = 0.16), EGA (p = 0.08), head circumference (p = 0.12), or birth weight (p = 0.05). These 78 patients underwent a total of 304 revision procedures, with a maximum of 17 revisions in 1 patient. The mean time to first revision was 410 ± 956 days, and the mean time from the first

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Jeremy S. Wetzel, David P. Heaner, Brandon C. Gabel, R. Shane Tubbs and Joshua J. Chern

are discussed further in the ensuing sections. Results Events at the Index Clinic Visit The average age in the clinical evaluation group and the surveillance imaging group was 10.4 (SD 6.1) and 8.0 (SD 6.1) years, respectively. The average length of follow-up in the 2 groups was 9.9 (SD 5.9) and 10.4 (SD 7.0) months, respectively. In the clinical evaluation group, 4 of 226 patients (1.8%) underwent shunt revision surgery based on clinical evidence of shunt malfunction ( Table 1 ). In all cases imaging studies were obtained after examination based on clinical

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Xin Zhou, C. Rory Goodwin, Pablo F. Recinos, Jesse X. Yang and George I. Jallo

leakage, meningitis, infection, neurological injury, and revision surgery, in pediatric cranial neurosurgery cases in which PEG sealant was used in combination with standard suture repair. Methods A retrospective analysis examining pediatric patients (age 0–18 years) who underwent cranial surgery at The Johns Hopkins Hospital during the period from August 2005 to July 2010 was performed. In all cases reviewed, the primary indication for the use of PEG sealant was as an adjunct to standard sutured dural closure techniques. A total of 163 patients were identified

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Mark R. Kraemer, Joyce Koueik, Susan Rebsamen, David A. Hsu, M. Shahriar Salamat, Susan Luo, Sara Saleh, Taryn M. Bragg and Bermans J. Iskandar

shunt exploration. Indications for nonurgent endoscopic ventricular or shunt surgery included endoscopic third ventriculostomy (ETV) to achieve shunt independence, reestablishment of shunt function after ETV failure, and shunt replacement or removal for infection management. All operative interventions were completed by the senior author. Endoscopic Shunt Revision Surgery At our institution, the scalp incision is opened and the proximal catheter disconnected from the valve. The distal system is then tested using a manometer. In the presence of normal distal runoff

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Pablo F. Recinos, Jonathan A. Pindrik, Mazen I. Bedri, Edward S. Ahn, George I. Jallo and Violette Renard Recinos

Art & Photography © 2011–2012. All Rights Reserved. Eight patients required revision surgery during the follow-up period ( Table 2 ). One patient (Case 11) experienced a case of distal failure in which the distal tubing retracted and became coiled under the shunt valve in the neck. The shunt was revised by an adult neurosurgeon through conversion to a minilaparotomy for replacement of the distal catheter. One shunt infection (5%) occurred requiring removal of the shunt system with delayed replacement after treatment with antibiotics (Case 14). One patient had

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Michael Vassilyadi, Zac L. Tataryn, Fahad Alkherayf, Kristin Udjus and Enrique C. G. Ventureyra

“routine” tests such as shunt series and neuroimaging is to identify early an emerging problem, such as a shunt malfunction. Other than identification on the clinical history and examination, a shunt malfunction may manifest as an increase in ventricular size on brain CT, MR imaging, or ultrasonography, absent or prolonged flow on a nuclear shuntogram, 12 or as a shunt extrusion, disconnection, or fracture on a shunt series. The purpose of this paper was to audit the usefulness of shunt series in detecting shunt malfunctions requiring shunt revision surgery. To this end

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Ken R. Winston, Elizabeth Trinidad, C. Corbett Wilkinson and Lori A. McBride


Cranial bandages are commonly applied over scalp incisions immediately after cerebrospinal fluid (CSF) shunt surgery, putatively to prevent complications, particularly infection. These bandages require resources, consume the time of healthcare workers, and incur non-negligible expenses. It is therefore both reasonable and important to examine the efficacy of cranial bandaging.


The combined experience of 3 neurosurgeons over 6.75 years with using no cranial bandaging after operations for implantation or revision of CSF shunts is the basis of this report. These data were prospectively accrued and retrospectively analyzed.


The infection rate was 4.2% (95% CI 3.1–5.6%) for 1064 operations performed without postoperative cranial bandaging after either shunt insertion or revision surgery through clean or clean-contaminated wounds. The age distribution extended from premature infants through adults 77 years of age.


The results of this investigation support the position that bandaging scalp wounds after CSF shunt implantation or revision surgery adds no benefit beyond the easier, simpler, faster, and cheaper practice of using antibiotic ointment as a dressing without bandaging.

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Garrett T. Venable, Nicholas B. Rossi, G. Morgan Jones, Nickalus R. Khan, Zachary S. Smalley, Mallory L. Roberts and Paul Klimo Jr.

explanations. Each variable was recorded per procedure. Preventable failure was defined as a failure subsequent to infection, malposition of the proximal or distal catheter, or an improperly assembled or inadequately secured shunt that resulted in postoperative disconnection, migration, kinking, or obstruction. This definition was agreed upon by the 3 primary authors (G.T.V., N.B.R., P.K.) after thorough deliberation of what were felt to be were unequivocal or near-unequivocal and potentially preventable reasons for revision surgery, which could be ascertained in the setting

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Victor M. Lu, Kevin Phan, Sean P. Crowley and David J. Daniels

authors for any clarification. Two investigators independently reviewed each retrieved article (V.M.L. and S.P.C.). Primary outcome measures included 1) surgical parameters such as LOS and estimated blood loss; and 2) performance parameters, such as postoperative complications; revision surgery; and improvements in syrinx, scoliosis, and overall clinical status. Definition of improvement was defined or implied on a study-to-study basis and included complete resolution. Examples of improvement in overall clinical status included complete remission of symptoms, 40

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Ashley Ralston, Patti Ogden, Michael H. Kohrman and David M. Frim

89% had no visible fracture of the leads. Their review showed no definitive increase in vascular injuries; however, they had significantly increased mean operating times: 94 minutes (range 53–195 minutes) for the initial lead placement of 15 patients included in their study compared with an average duration of 173 minutes (range 108–273 minutes) for the 24 revision surgeries. 1 Electrode replacement requires exposure of the vagus nerve in the neck and places the carotid artery and internal jugular vein at increased risk of injury. Several studies have been