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Dachling Pang and Paul A. Grabb

the other three, the ventricular catheter was occluded 4, 9, and 13 months after shunt placement, giving a proximal shunt failure rate of 1.9%. Catheter Position Of the 112 sets of postoperative skull films and CT scans available for grading ventricular catheter tip positioning, 59 catheters (52.7%) were judged to be in an excellent position ( Fig. 3 ), 37 (33%) in a good position, and seven (6.3%) in a poor position. Nine catheters (8%) were displaced by large intraventricular masses. If these nine displaced catheters were discarded from the analysis for the

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Sandeep Sood, Ryan J. Barrett, Tiffany Powell and Steven D. Ham

an LP shunt. Rekate and Wallace 26 performed a retrospective review of 25 patients with LP shunts and described nine patients with a severe form of slit ventricles, incapacitating headaches, and recurrent proximal shunt failure. They did not, however, describe the effect of LP shunts on the rate of subsequent malfunctions. Finally, Le, et al., 18 retrospectively reviewed seven patients with a diagnosis of SVS who had presented with intermittent symptoms of apparent shunt malfunction, small ventricles visible on CT scans, and a functioning shunt demonstrated

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Christina Notarianni, Prasad Vannemreddy, Gloria Caldito, Papireddy Bollam, Esther Wylen, Brian Willis and Anil Nanda

literature remains undecided. Ringel et al. 19 found that programmable valves did not reduce the number of surgical shunt revisions in adult patients. McGirt et al. 14 concluded that programmable valves decreased the risk of proximal obstruction and shunt malfunctions, advocating the use of programmable valves in patients who begin experiencing frequent proximal shunt failures. At our institution we have most often used the Medtronic pressure-controlled flow valves, Medtronic Strata programmable valves, and in a few cases, Codman-Hakim programmable valves. Our results

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Elvis J. Hermann, Hans-Holger Capelle, Christoph A. Tschan and Joachim K. Krauss

al. 6 In that study, the proximal shunt failure rate was 9%, which was lower than reported failure rates using conventional techniques. 15 , 35 Follow-up was limited, however, and children younger than 2 years were not included. In a recent prospective multicenter study, 41 patients had received ventricular catheters using standard techniques and 34 using electromagnetic guidance. 10 Patients with slit ventricles were excluded. The number of catheters placed in an optimal position in the ventricles was significantly increased by electromagnetic guidance

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Sarah T. Garber, Jay Riva-Cambrin, Frank S. Bishop and Douglas L. Brockmeyer

.02). Seventeen (94.4%) of the suboccipital shunt placements were original placements, and 1 was placed after a shunt placed via the SPT approach failed. Six (54.6%) of the fourth ventricle shunt placements were original placements, and 5 were placed after a fourth ventricle shunt placed via the suboccipital approach failed. Patient demographics, cause of fourth ventricle hydrocephalus, comorbid conditions, number of revisions prior to a fourth ventricle shunt, and the reason for shunt failure did not differ significantly between approaches ( Table 2 ). Although proximal shunt

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Thomas J. Wilson, William R. Stetler Jr., Wajd N. Al-Holou and Stephen E. Sullivan

reduce shunt failure by optimizing each component of the system. Conclusions Based on this study, both stereotactic- and ultrasound-guided ventricular catheter placements are significantly more accurate than freehand placement based on surface anatomy. The only risk factor identified in this study for inaccurate placement was the use of the freehand technique. Notably, ventricular size did not correlate with risk of inaccuracy. The increased accuracy of stereotactic- and ultrasound-guided ventricular catheter placements led to a reduction in proximal shunt

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Richard P. Menger, David E. Connor Jr., Jai Deep Thakur, Ashish Sonig, Elainea Smith, Bharat Guthikonda and Anil Nanda

operative room was significantly increased but actual operative time was similar to published series using the freehand technique. 21 All shunts were placed with ideal end points in 1 pass. The placement of VP shunts with image guidance shows increased accuracy and decreased proximal failures. 25 In 2013, Wilson et al. published a retrospective cohort study, in which 12% of shunts placed by freehand for hydrocephalus, for all causes, developed a proximal shunt failure. 25 Overall there was a 16% failure rate with freehand shunt placement in this study. Only 4% of the

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Joanna Kemp, Ann Marie Flannery, Mandeep S. Tamber and Ann-Christine Duhaime

S hunt malfunction remains a significant source of morbidity in patients with shunted hydrocephalus. One variable affecting the risk of proximal shunt failure includes the entry point and position of the ventricular catheter. Entry from the skull is situated to access the ventricle without penetrating eloquent cortex. Although the optimal target is unclear, it has been suggested that positioning the tip of the ventricular catheter away from the wall of the ventricle and choroid plexus would improve shunt survival. In general, entry points most often

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William W. Scott, Bradley E. Weprin and Dale M. Swift

a VP shunt procedure, while 4 children (33%) underwent ETV. No complications from or revisions for ETV procedures have thus far been reported in these few cases; however, in the shunt-treated cases, 2 children required revision, representing a 25% shunt revision rate. In both of these cases proximal shunt failure was encountered, related to bony overgrowth at the site of the valve and/or proximal portion of the ventricular catheter. After revision, it appears that these children quickly return to their preoperative neurological state. A review of the

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Philippe Schucht, Vanessa Banz, Markus Trochsler, Samuel Iff, Anna Katharina Krähenbühl, Michael Reinert, Jürgen Beck, Andreas Raabe, Daniel Candinas, Dominique Kuhlen and Luigi Mariani

statistically significant (p = 0.78). The age-adjusted hazard ratio was 1.34 (95% CI 0.51–3.53). TABLE 2 Summary of all complications and VP shunt failures in the first 12 months after surgery Description No. of Patients (%) p Value Laparoscopic (n = 60) Mini-Laparotomy (n = 60) Overall complications & failures requiring surgical intervention 9 (15.0%) 11 (18.3%) 0.40 * Distal shunt failure 0 (0%) 5 (8.3%) 0.03 * Proximal shunt failure (failure of cranial catheter or valve) 5 (8.3%) 2 (3.3%) 0