{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:02:40Z","timestamp":1786125760406,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2019,2,7]],"date-time":"2019-02-07T00:00:00Z","timestamp":1549497600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ mailto:journals.permissions@oup.com"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Implantable shunt devices are critical and life saving for hydrocephalus patients. However, these devices are fraught with high complication rates including scalp dehiscence, exposure, and extrusion. In fact, high shunt valve profiles are correlated with increased complications compared to those with lower profiles. As such, we sought a new method for integrating shunt valves for those challenging patients presenting with scalp-related complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To safely implant and integrate a hydrocephalus shunt valve device within a customized cranial implant, in an effort to limit its high-profile nature as a main contributor to shunt failure and scalp breakdown, and at the same time, improve patient satisfaction by preventing contour deformity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A 64-yr-old male presented with an extruding hydrocephalus shunt valve and chronic, open scalp wound. The shunt valve was removed and temporary shunt externalization was performed. He received 2 wk of culture-directed antibiotics. Next, a contralateral craniectomy was performed allowing a new shunt valve system to be implanted within a low-profile, customized cranial implant. All efforts were made, at the patient's request, to decrease the high-profile nature of the shunt valve contributing to his most recent complication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>First-in-human implantation was performed without complication. Postoperative shunt identification and programming was uncomplicated. The high-profile nature of the shunt valve was decreased by 87%. At 10 mo, the patient has experienced no complications and is extremely satisfied with his appearance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>This first-in-human experience suggests that a high-profile hydrocephalus shunt device may be safely integrated within a customized cranial implant.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opz003","type":"journal-article","created":{"date-parts":[[2019,2,6]],"date-time":"2019-02-06T22:50:01Z","timestamp":1549493401000},"page":"608-615","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":30,"title":["First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant"],"prefix":"10.1227","volume":"17","author":[{"given":"Chad R","family":"Gordon","sequence":"first","affiliation":[{"name":"Division of Neuroplastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland"},{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Wolff","sequence":"additional","affiliation":[{"name":"Division of Neuroplastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland"},{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel F","family":"Santiago","sequence":"additional","affiliation":[{"name":"Division of Neuroplastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland"},{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Liebman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Drexel College of Medicine, Philadelphia, Pennsylvania"},{"name":"Global Neurosciences Institute, Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erol","family":"Veznedaroglu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Drexel College of Medicine, Philadelphia, Pennsylvania"},{"name":"Global Neurosciences Institute, Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank D","family":"Vrionis","sequence":"additional","affiliation":[{"name":"Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0675-1935","authenticated-orcid":false,"given":"Judy","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Brem","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Luciano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,12]]},"reference":[{"issue":"1","key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"e013389","DOI":"10.1136\/bmjopen-2016-013389","article-title":"Forty years of shunt surgery at Rigshospitalet, Denmark: a retrospective study comparing past and present rates and causes of revision and infection","volume":"7","author":"Kofoed Mansson","year":"2017","journal-title":"BMJ Open"},{"issue":"1-2","key":"bib2-20240909","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.wneu.2011.10.034","article-title":"Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-Term single institution experience","volume":"78","author":"Reddy","year":"2012","journal-title":"World Neurosurg"},{"issue":"8","key":"bib3-20240909","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1007\/BF00335075","article-title":"Time-related patterns of ventricular shunt failure","volume":"10","author":"Kast","year":"1994","journal-title":"Child's Nerv Syst"},{"issue":"2","key":"bib4-20240909","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.wneu.2013.01.096","article-title":"Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus","volume":"81","author":"Reddy","year":"2014","journal-title":"World Neurosurg"},{"issue":"4","key":"bib5-20240909","doi-asserted-by":"crossref","first-page":"725","DOI":"10.3171\/jns.2003.98.4.0725","article-title":"Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial","volume":"98","author":"Zabramski","year":"2003","journal-title":"J Neurosurg"},{"issue":"1","key":"bib6-20240909","doi-asserted-by":"crossref","first-page":"139","DOI":"10.3171\/2014.9.JNS131277","article-title":"Cost-consequence analysis of antibiotic-impregnated shunts and external ventricular drains in hydrocephalus","volume":"122","author":"Edwards","year":"2015","journal-title":"J Neurosurg"},{"issue":"10","key":"bib7-20240909","doi-asserted-by":"crossref","first-page":"13030\/qt2rs544f9","DOI":"10.5070\/D32110028947","article-title":"Scalp necrosis overlying a ventriculoperitoneal shunt: a case report and literature review","volume":"21","author":"Nguyen","year":"2015","journal-title":"Dermatol Online J"},{"issue":"3","key":"bib8-20240909","doi-asserted-by":"crossref","first-page":"186","DOI":"10.7181\/acfs.2017.18.3.186","article-title":"Cranial defect overlying a ventriculoperitoneal shunt: pressure gradient leading to free flap deterioration?","volume":"18","author":"Joo","year":"2017","journal-title":"Arch Craniofac Surg"},{"issue":"1)","key":"bib9-20240909","first-page":"25","article-title":"Factors affecting ventriculoperitoneal shunt survival in adult patients","volume":"6","author":"Khan","year":"2015","journal-title":"Surg Neurol Int"},{"key":"bib10-20240909","article-title":"\u201cReverse J Shaped\u201d skin flap and cranial bone groove for shunt hardware: a new technique in patients with fragile skin","author":"Cakir","journal-title":"Turk Neurosurg"},{"issue":"11","key":"bib11-20240909","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1007\/s00381-015-2865-5","article-title":"Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency","volume":"31","author":"Wang","year":"2015","journal-title":"Childs Nerv 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