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

-center experience using both. 14 , 28 In 2009, the Hydrocephalus Clinical Research Network (HCRN) published an initial paper in which the permanent shunt rates were evaluated in a 147-patient retrospective non-standardized cohort. Use of a ventricular reservoir (VR) led to a lower rate of permanent shunt placement in a statistically significant fashion. 30 However, institutional bias as denoted by “center effect” was noted in subsequent publications. 24 Therefore, the HCRN developed standardized management rubrics that were based on findings in the prior 2 studies 24 , 30 and

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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

. Pediatr Neurosurg 30 : 57 – 61 , 1999 5 Kestle JR , Drake JM , Cochrane DD , Milner R , Walker ML , Abbott R III , : Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial . J Neurosurg 98 : 284 – 290 , 2003 6 Kestle JR , Riva-Cambrin J , Wellons JC III , Kulkarni AV , Whitehead WE , Walker ML , : A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. Clinical article . J Neurosurg

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

(ETVSS) 15 has helped surgeons predict the success of the procedure based on preoperative factors, the identification of important intraoperative factors may further help surgeons in decision making and perhaps provide insight into the essential technical elements of an optimal ETV. The Hydrocephalus Clinical Research Network (HCRN), a multicenter North American research collaborative, began in 2007, as part of its core data registry, a prospective study of ETV in children. This involved real-time, contemporaneous collection of data, including intraoperative details

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

a prospective study within the Hydrocephalus Clinical Research Network (HCRN; Appendix 1 ) to describe the success and complications of ETV+CPC in infants and to compare results to a historical cohort of infants treated with either shunt placement or ETV alone. Uniquely, in the current multicenter prospective study, we applied a predefined consensus definition for infants with hydrocephalus who were eligible for ETV+CPC, as well as a strict definition for treatment failure. Methods The study population consisted of infants (corrected age ≤ 24 months) receiving

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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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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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Michael A. Williams, Sean J. Nagel, Mark G. Luciano, Norman Relkin, Thomas J. Zwimpfer, Heather Katzen, Richard Holubkov, Abhay Moghekar, Jeffrey H. Wisoff, Guy M. McKhann II, James Golomb, Richard J. Edwards and Mark G. Hamilton

centers have programs dedicated to the care of these patients. 30 Consequently, most are cared for by neurosurgeons and neurologists who are familiar with hydrocephalus but may not have the clinical expertise necessary to care for the full spectrum of adults with hydrocephalus. The Adult Hydrocephalus Clinical Research Network (AHCRN) was founded in 2014, modeled after the Hydrocephalus Clinical Research Network (HCRN), which has focused its research on issues vital to the safe and successful treatment of children with hydrocephalus ( http://www.hcrn.org ). The AHCRN