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Jonathan Pindrik, Jay Riva-Cambrin, Abhaya V. Kulkarni, Jessica S. Alvey, Ron W. Reeder, Ian F. Pollack, John C. Wellons III, Eric M. Jackson, Curtis J. Rozzelle, William E. Whitehead, David D. Limbrick Jr., Robert P. Naftel, Chevis Shannon, Patrick J. McDonald, Mandeep S. Tamber, Todd C. Hankinson, Jason S. Hauptman, Tamara D. Simon, Mark D. Krieger, Richard Holubkov, John R. W. Kestle and for the Hydrocephalus Clinical Research Network

rates of CSF infection (1%–6%) than has CSF shunt surgery (6%–15%). 1 , 2 , 4 , 7–14 Rates of shunt infection per procedure vary between 4% and 17% based on multiple studies, 3 , 7–16 with greater risk ratios demonstrated following shunt revision (1 revision, HR 3.0–3.9; ≥ 2 revisions, HR 6.5–13.0). 13 , 14 Measures developed and adopted by the Hydrocephalus Clinical Research Network (HCRN) have resulted in an 18% risk reduction of time to first shunt failure 17 and a 3% decline (8.5%–5.7%) in shunt infection rates within HCRN centers. 9 Despite these efforts and

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Jay Riva-Cambrin, John R. W. Kestle, Curtis J. Rozzelle, Robert P. Naftel, Jessica S. Alvey, Ron W. Reeder, Richard Holubkov, Samuel R. Browd, D. Douglas Cochrane, David D. Limbrick Jr., Chevis N. Shannon, Tamara D. Simon, Mandeep S. Tamber, John C. Wellons III, William E. Whitehead, Abhaya V. Kulkarni and for the Hydrocephalus Clinical Research Network

91 infants with hydrocephalus. 16 Other single-center studies without affiliation with CCHU have reported significantly lower success rates of 37%–42%. 3 , 23 The Hydrocephalus Clinical Research Network (HCRN) itself has previously published studies demonstrating varying overall ETV+CPC success rates. Originally, the HCRN published a retrospective 7-center study (n = 36) that found a more moderate 52% overall success rate at 6 months before any formal training relationship with CCHU. 8 More recently, the HCRN published a 9-center prospective cohort study (n

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Abhaya V. Kulkarni, Jay Riva-Cambrin, Jerry Butler, Samuel R. Browd, James M. Drake, Richard Holubkov, John R. W. Kestle, David D. Limbrick, Tamara D. Simon, Mandeep S. Tamber, John C. Wellons III, William E. Whitehead and for the Hydrocephalus Clinical Research Network

A lthough CSF shunting has been the most widely used treatment for hydrocephalus over the past half century, it is unclear whether outcomes of shunting have improved dramatically over time. Since 2006, the HCRN, a multicenter network of pediatric neurosurgical institutions, has been dedicated to collecting high-quality data on the outcomes of hydrocephalus treatment in children. 6 , 11 , 13 The HCRN currently comprises 7 centers in North America and provides a unique opportunity for assessing the current outcomes of CSF shunting in nonselected patients

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John R. W. Kestle, Richard Holubkov, D. Douglas Cochrane, Abhaya V. Kulkarni, David D. Limbrick Jr., Thomas G. Luerssen, W. Jerry Oakes, Jay Riva-Cambrin, Curtis Rozzelle, Tamara D. Simon, Marion L. Walker, John C. Wellons III, Samuel R. Browd, James M. Drake, Chevis N. Shannon, Mandeep S. Tamber, William E. Whitehead and The Hydrocephalus Clinical Research Network

I nfection continues to be a common complication of CSF shunts for children with hydrocephalus, and there are ongoing efforts to identify methods or devices that may reduce this risk. Quality-improvement research has suggested that standardized protocols may reduce device-related infection in a number of areas. 1 , 3 , 11 The Hydrocephalus Clinical Research Network (HCRN) has used this approach to minimize shunt infection rates since 2007. A protocol was developed using the available literature that included 11 steps aimed at reducing infection, such as

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Michael M. H. Yang, Walter Hader, Kelly Bullivant, Mary Brindle and Jay Riva-Cambrin

manage a shunt infection is estimated to be $30,000, leading to $259 million in hospital charges in 2003. 23 Efforts have been made to identify modifiable risk factors and create standardize protocols to help reduce shunt infections in children. 10 , 12–14 , 21 Kestle et al. 14 published a paper for the Hydrocephalus Clinical Research Network (HCRN), presenting a standardized protocol for shunt insertions that led to a 36% relative risk reduction and a 3.2% absolute risk reduction in the number of shunt infections across 4 centers. Despite their study being a

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John R. W. Kestle, Jay Riva-Cambrin, John C. Wellons III, Abhaya V. Kulkarni, William E. Whitehead, Marion L. Walker, W. Jerry Oakes, James M. Drake, Thomas G. Luerssen, Tamara D. Simon and Richard Holubkov

centers. 6 To our knowledge, the application of standardized preoperative protocols across multiple centers has not been conducted in neurosurgery. Our goal was to apply these quality improvement methodologies to CSF shunt surgery in an effort to reduce the 6-month infection rate. Methods Study Setting The HCRN is a collaboration of pediatric neurosurgical centers conducting systematic investigations in the management of pediatric hydrocephalus. In an effort to reduce the risk of shunt infection, a quality improvement methodology was adopted by HCRN centers

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Jay Riva-Cambrin, John R. W. Kestle, Richard Holubkov, Jerry Butler, Abhaya V. Kulkarni, James Drake, William E. Whitehead, John C. Wellons III, Chevis N. Shannon, Mandeep S. Tamber, David D. Limbrick Jr., Curtis Rozzelle, Samuel R. Browd, Tamara D. Simon and The Hydrocephalus Clinical Research Network

was conducted by the Hydrocephalus Clinical Research Network (HCRN), a 9-center collaborative group focused on improving the lives of children with hydrocephalus through epidemiological investigations of clinical outcomes. Methods Study Population Inclusion criteria for this multicenter prospective cohort study were as follows. The patients had to be children younger than 19 years of age undergoing their first insertion of a CSF shunt for treatment of hydrocephalus. All children were consecutively identified at one of the 6 participating HCRN centers

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Abhaya V. Kulkarni, Jay Riva-Cambrin, Samuel R. Browd, James M. Drake, Richard Holubkov, John R. W. Kestle, David D. Limbrick, Curtis J. Rozzelle, Tamara D. Simon, Mandeep S. Tamber, John C. Wellons III and William E. Whitehead

The procedure failed in a total of 6, all of whom had demonstrated prepontine cisternal scarring at surgery and on preoperative fast imaging employing steady-state acquisition/constructive interference in steady state (FIESTA/CISS) MRI studies. When this report was prepared, the Hydrocephalus Clinical Research Network (HCRN) comprised 7 pediatric neurosurgery centers dedicated to the study of children with hydrocephalus. As a first step in investigating the efficacy of ETV + CPC, we retrospectively reviewed the outcome of ETV + CPC procedures that had been

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John C. Wellons III, Richard Holubkov, Samuel R. Browd, Jay Riva-Cambrin, William Whitehead, John Kestle, Abhaya V. Kulkarni and for the Hydrocephalus Clinical Research Network

T he assessment of evidence of increased ICP in infants, particularly premature infants, often rests on clinical examination features. The hallmark clinical features include increased head circumference, bulging of the anterior fontanel, and splitting of the cranial sutures. In the process of trying to standardize the management of premature infants with intraventricular hemorrhage, our group, the HCRN, developed treatment rubrics for the clinical assessment of increased ICP. For such treatment rubrics to be useful, however, the clinical assessment

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Jay Riva-Cambrin, Chevis N. Shannon, Richard Holubkov, William E. Whitehead, Abhaya V. Kulkarni, James Drake, Tamara D. Simon, Samuel R. Browd, John R. W. Kestle and John C. Wellons III

birth weights (62,000 infants/year). 6 Hintz et al. 8 demonstrated that approximately 36% of extremely premature (< 25 weeks) infants develop Grade III or IV IVH. In a retrospective, multicenter cohort of preterm infants with IVH within the HCRN, our group has found that 40% of these patients required some treatment for hydrocephalus, of which 78% underwent permanent shunt insertions. 18 Hence, we can expect approximately 9000 new children per year in the US with hydrocephalus from prematurity alone. The management of hydrocephalus in this population is complex