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Brandon G. Rocque, Raymond P. Waldrop, Isaac Shamblin, Anastasia A. Arynchyna, Betsy Hopson, Tammie Kerr, James M. Johnston, Curtis J. Rozzelle, and Jeffrey P. Blount

data from a large prospective trial put the failure rate for shunts placed in infancy at approximately 40% in the 1st year and 50% in the first 2 years. 3 However, a single shunt failure is often not a major burden. It is the children who have multiple and frequent shunt failures who have the highest burden of suffering and require disproportionate attention from pediatric neurosurgeons. Risk factors for multiple shunt failures have been identified in previous single-institution studies. They include history of traumatic brain injury, slit-like ventricles, high CSF

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Ariana Adamski, Michael W. O’Brien, and Matthew A. Adamo

C erebrospinal fluid shunt placement is a common neurosurgical intervention for both pediatric and adult populations. It is performed to address elevated intracranial pressure and hydrocephalus stemming from an array of neurological etiologies. 1 , 2 Despite constant technological advances in shunt equipment and placement, shunt failure commonly occurs within the 1st year of placement and remains a risk factor for patients throughout the duration of their shunt placement. 3 , 4 Shuntograms are a diagnostic tool used to assess shunt patency in patients

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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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Phumtham Limwattananon and Amnat Kitkhuandee

. Ventriculoperitoneal (VP) shunting is one of the most common operations performed in the treatment of hydrocephalus since its advent in the 1950s, and it accounts for a large part of the pediatric neurosurgical practice. 2 , 3 Despite advancements in surgical techniques and equipment, VP shunting had a high failure rate. 4–7 Patients with VP shunts may have multiple admissions and shunt revisions over their shunt-dependent lives. Most shunt failures are caused by infection or mechanical complications of the shunt system and occur more frequently within the first 2 years after

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Phumtham Limwattananon and Amnat Kitkhuandee

. Ventriculoperitoneal (VP) shunting is one of the most common operations performed in the treatment of hydrocephalus since its advent in the 1950s, and it accounts for a large part of the pediatric neurosurgical practice. 2 , 3 Despite advancements in surgical techniques and equipment, VP shunting had a high failure rate. 4–7 Patients with VP shunts may have multiple admissions and shunt revisions over their shunt-dependent lives. Most shunt failures are caused by infection or mechanical complications of the shunt system and occur more frequently within the first 2 years after

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

and prolonged hospitalizations, as well as morbidity related to repeated shunt operations. 1–3 This problem also contributes to frustration and stress for the child, family, and treating neurosurgeon. Prior work has suggested that age at the time of initial shunt insertion and time interval since prior surgical revision may be significant risk factors for repeated future shunt failure, regardless of timing. 4 There may also be a tendency for intervals between shunt failures to shorten as repeated failures occur. 5 The primary objective of this study was to use the

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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