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Ciaran J. Powers, Timothy George and Herbert E. Fuchs

T he prevalence of hydrocephalus has been estimated at 1 to 1.5% and the incidence of congenital hydro-cephalus at 1 to 2 per 1000 births. 8 The origin of hydrocephalus in children is most often congenital (nearly 70% of cases, with perinatal intracranial hemorrhage and tumor accounting for 10% each). 1 Currently the treatment of choice for most of these patients is VP shunt placement. Unfortunately, shunt failure rates are high, especially in children. The 1-year failure rate has been reported to be approximately 40% 6 and the 10-year failure rate to be

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Robert P. Naftel, Emily Tubergen, Chevis N. Shannon, Kimberly A. Gran, E. Haley Vance, W. Jerry Oakes, Jeffrey P. Blount and John C. Wellons III

C hildren with shunted hydrocephalus often have multiple medical comorbidities and regularly present to hospitals with a variety of symptoms that may or may not be related to shunt failure. Medical personnel must differentiate benign conditions from more critical diagnoses. Physicians make clinical decisions by assigning value to symptoms, signs, and test results, and then synthesize these values while weighing the risk of a missed diagnosis. 15 There is no gold standard for the preoperative diagnosis of shunt failure. 2 , 6 , 9 Untreated or

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David M. Katz, Jonathan D. Trobe, Karin M. Muraszko and Robert C. Dauser

was no somnolence, irritability, vomiting, or complaint of headache. Computerized tomography (CT) of the brain showed no evidence of ventriculomegaly, flattening of sulci, or enlargement of subarachnoid spaces. A shunt catheter was noted in the right lateral ventricle ( Fig. 1 ). Because of the lack of ventriculomegaly, shunt failure was dismissed as a cause of the symptoms. Fig. 1. Case 1. Computerized tomography axial scans performed before shunt revision (A–C) do not disclose ventriculomegaly, flattened sulci, or enlarged subarachnoid spaces; scans

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Hsin-Hung Chen, Jay Riva-Cambrin, Douglas L. Brockmeyer, Marion L. Walker and John R. W. Kestle

I nsertion or revision of a CSF shunt for the management of hydrocephalus is the most common procedure in pediatric neurosurgical practice. Shunt failure remains all too common and is usually due to obstruction or infection. 8 , 13 Disconnection, or separation of components after implantation, may occur in multicomponent shunt systems. 1 A one-piece shunt system has been designed to eliminate disconnection, 6 , 12 but multicomponent systems are much more commonly used. The shunt system used most often in our practice consists of two components: 1) a

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Dennis L. Johnson, Charles Fitz, David C. McCullough and Saul Schwarz

bifida 1 12–24 vomiting 1 survived 4 spina bifida 3 8–12 headache 1 survived 5 spina bifida 17 8–12 headache 1 survived 6 aqueductal stenosis 8 12–24 headache 12 survived 7 intraventricular hemorrhage 4 4–6 headache 0 survived * This case is the same as Case 1 in Table 2 . Fig. 1. Computerized tomography scans in Case 7. Upper: The perimesencephalic cistern is not visible at the time of acute shunt failure. Lower: Three days later, after shunt

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Michael J. Ellis, Colin J. Kazina, Marc R. Del Bigio and Patrick J. McDonald

F or > 50 years, VP shunts have been used as the principle surgical treatment of pediatric hydrocephalus. The 2 most common factors contributing to shunt malfunction are infection and mechanical obstruction of the ventricular catheter by tissue from brain and inflammatory processes. 11 , 18 One inflammatory phenomenon that has been repeatedly linked to shunt malfunction is CSF eosinophilia. 2 , 25 The role of silicone allergy in shunt failure and CSF eosinophilia is poorly understood. We describe the case of a child with a latex allergy who presented

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Terje Sæhle and Per Kristian Eide

S hunt surgery is the primary treatment of pediatric and adult hydrocephalus, 42 although shunt failure requiring shunt revision is frequent. 2 , 8 , 12 , 45 Shunt failure may be accompanied by over- or underdrainage of CSF. When the shunt is draining too much CSF (overdrainage), symptoms such as headache and dizziness may arise. 9 , 37 However, symptoms such as headache and dizziness may also be caused by CSF underdrainage, e.g., due to obstruction of the CSF catheter. 10 The shunt valves with adjustable CSF opening pressure have been reported to

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Kimitoshi Sato, Satoru Shimizu, Satoshi Utsuki, Sachio Suzuki, Hidehiro Oka and Kiyotaka Fujii

T he CHPV system is gaining widespread use because of its convenience and reliability, but obstruction or breakage associated with its small and fragile structure is occasionally reported. 6–8 , 10–12 In the present article, we describe a case of shunt failure due to head banging. This type of shunt malfunction has not been reported previously. Case Report History This 7-year-old girl was admitted to our institution in a comatose state. At 3 months of age she had undergone placement of a ventriculoperitoneal shunt and CHPV system (Codman

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Chevis N. Shannon, Tamara D. Simon, Gavin T. Reed, Frank A. Franklin, Russell S. Kirby, Meredith L. Kilgore and John C. Wellons III

burden to the family unit. Families caring for children with hydrocephalus incur out-of-pocket expenses each time their child has a shunt failure episode. This study is based on the hypothesis that hydrocephalus is no different from other chronic childhood illnesses, and its objectives were to determine the third-party payer reimbursement rate for a VP shunt failure episode, and out-of-pocket expenses associated with shunt failure episodes. Methods Study Design A retrospective observational study of patients who underwent initial VP shunt placement at the CHA

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Anand I. Rughani, Bruce I. Tranmer, Jeffrey E. Florman and James T. Wilson

A ccurate diagnosis of VP shunt malfunction is a common and sometimes challenging clinical task that most neurosurgeons face. Although a new shunt has an expected survival of approximately 73 months, 5 the failure rate is reported to be 48% at 2 years and 59% at 4 years following placement. 4 Mechanical failures in general represent 74% of shunt malfunctions. 4 Disconnection or fracture is reported to account for approximately 15% of all shunt failures. 1 , 4 Radiographic assessment remains a fundamental adjunct to diagnosis of shunt failure, 3 but one