{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T22:37:48Z","timestamp":1776465468666,"version":"3.51.2"},"reference-count":26,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground<\/jats:title>\nAs the population continues to age, the number of adults receiving care for hydrocephalus is expected to increase. Here, we assess trends in the utilization and physician reimbursement for ventriculoperitoneal shunts (VPS), lumboperitoneal shunting (LPS), and endoscopic third ventriculostomy (ETV) for adult hydrocephalus.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nThe Medicare Part B National Summary Data files from 2000 to 2021 were collected, and information was extracted on procedures performed per year, total charges billed, and actual payments. Linear mixed-model regression analyses were conducted to assess the significance of changes in procedural volume and physician reimbursement over time while adjusting for inflation.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nOver the period studied, there was a 26% increase in VPS placement (P<\/jats:italic> = 0.11), 11.34% increase in ETV utilization (P<\/jats:italic> < 0.01), and 43.1% decrease in LPS utilization (P<\/jats:italic> < 0.01). This corresponded to annualized changes of + 4.29% for ETV procedures, \u22128.78% for LPS, and + 45.8% for VPS. There was a statistically significant difference in the change of rate of number of procedures annually between LPS and VPS (P<\/jats:italic> = 0.04). In both inflation-unadjusted and inflation-adjusted analyses, all procedures experienced an annual decline in reimbursement with inflation-adjusted changes of \u221211.54%\/year for ETV, \u22124.13% for LPS, and \u221213.12% for VPS. There was a statistically significant difference in the change of rate of reimbursement between LPS procedures and both ETV (P<\/jats:italic> < 0.01) and VPS (P<\/jats:italic> < 0.01).<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nMedicare reimbursement data shows that a commensurate decline in physician reimbursement has accompanied the ongoing rise in adult hydrocephalus procedures.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_209_2025","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T10:14:43Z","timestamp":1746180883000},"page":"162","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cerebrospinal fluid diversion procedure utilization and physician reimbursement in adult hydrocephalus patients"],"prefix":"10.25259","volume":"16","author":[{"given":"Melanie","family":"Alfonzo Horowitz","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Orange, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Orange, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nolan J.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, Irvine, Orange, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saarang","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, Seton Hall University, South Orange Village, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Faizan","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachiv","family":"Chakravarti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Orange, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Mirahmadi Eraghi","sequence":"additional","affiliation":[{"name":"School of Medicine, Qeshm International Branch, Islamic Azad University, Qeshm, Iran"},{"name":"Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian Lassiter","family":"Gendreau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Orange, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin D.","family":"Elder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"10.25259\/SNI_209_2025\/ref-1","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1016\/j.wneu.2020.09.012","article-title":"Prevalence and trends in management of idiopathic normal pressure hydrocephalus in the United States: Insights from the national inpatient sample","volume":"145","author":"Alvi","year":"2021","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_209_2025\/ref-2","article-title":"Survey of Medicare participation among neurosurgeons","author":"American Association of Neurological Surgeons Congress of Neurological 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