{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:32:02Z","timestamp":1791444722618,"version":"4.3.3"},"reference-count":198,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2012,11]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in CSF shunt surgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge regarding methods for their reduction. This review may also inform future and ongoing efforts for the advancement of neurosurgical quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors performed a PubMed search using search terms \u201ccerebral shunt,\u201d \u201ccerebrospinal fluid shunt,\u201d \u201cCSF shunt,\u201d \u201cventriculoperitoneal shunt,\u201d \u201ccerebral shunt AND complications,\u201d \u201ccerebrospinal fluid shunt AND complications,\u201d \u201cCSF shunt AND complications,\u201d and \u201cventriculoperitoneal shunt AND complications.\u201d Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to be included to maximize the range of rates of occurrence for the adverse events reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In this review of the neurosurgery literature, the reported rate of mechanical malfunction ranged from 8% to 64%. The use of programmable valves has increased but remains of unproven benefit even in randomized trials. Infection was the second most common complication, with the rate ranging from 3% to 12% of shunt operations. A meta-analysis that included 17 randomized controlled trials of perioperative antibiotic prophylaxis demonstrated a decrease in shunt infection by half (OR 0.51, 95% CI 0.36\u20130.73). Similarly, use of detailed protocols including perioperative antibiotics, skin preparation, and limitation of OR personnel and operative time, among other steps, were shown in uncontrolled studies to decrease shunt infection by more than half.<\/jats:p>\n                    <jats:p>Other adverse events included intraabdominal complications, with a reported incidence of 1% to 24%, intracerebral hemorrhage, reported to occur in 4% of cases, and perioperative epilepsy, with a reported association with shunt procedures ranging from 20% to 32%. Potential management strategies are reported but are largely without formal evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Surgery for CSF shunt placement or revision is associated with a high complication risk due primarily to mechanical issues and infection. Concerted efforts aimed at large-scale monitoring of neurosurgical complications and consistent quality improvement within these highlighted realms may significantly improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2012.7.focus12179","type":"journal-article","created":{"date-parts":[[2012,11,1]],"date-time":"2012-11-01T09:58:51Z","timestamp":1351763931000},"page":"E13","source":"Crossref","is-referenced-by-count":89,"title":["Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery"],"prefix":"10.3171","volume":"33","author":[{"given":"Judith M.","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Harvard School of Public Health;"},{"name":"Center for Surgery and Public Health"},{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Ziewacz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan Health Systems, Ann Arbor, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen L.","family":"Ho","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaykar R.","family":"Panchmatia","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma, Heatherwood and Wexham Park Hospitals, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela M.","family":"Bader","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Harvard School of Public Health;"},{"name":"Center for Surgery and Public Health"},{"name":"Departments of Anesthesiology, Perioperative and Pain Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh J.","family":"Garton","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Harvard School of Public Health;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R.","family":"Laws","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul A.","family":"Gawande","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Harvard School of Public Health;"},{"name":"Center for Surgery and Public Health"},{"name":"Surgery, Brigham and Women's Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0330013","series-title":"Curr Surg","first-page":"338","article-title":"Intra-abdominal pseudocysts as a complication of ventriculoperitoneal shunts: a case report and review of the literature","volume":"60","author":"Anderson","year":"2003"},{"key":"b2-0330013","series-title":"Neurosurgery","first-page":"284","article-title":"Hospital costs associated with shunt infections in patients receiving antibiotic-impregnated shunt catheters versus standard shunt catheters","volume":"66","author":"Attenello","year":"2010"},{"key":"b3-0330013","series-title":"J Neurosurg","first-page":"247","article-title":"Duration of protective activity of cerebrospinal fluid shunt catheters impregnated with antimicrobial agents to prevent bacterial catheter-related infection","volume":"87","author":"Bayston","year":"1997"},{"key":"b4-0330013","series-title":"Curr Opin Neurol","first-page":"661","article-title":"Management of hydrocephalus with programmable valves after traumatic brain injury and subarachnoid hemorrhage","volume":"13","author":"Bergsneider","year":"2000"},{"key":"b5-0330013","series-title":"Pediatr Neurosurg","first-page":"169","article-title":"Transoral protrusion of a peritoneal catheter: a rare complication of ventriculoperitoneal shunt","volume":"44","author":"Berhouma","year":"2008"},{"key":"b6-0330013","series-title":"J Neurosurg","first-page":"274","article-title":"Epilepsy in children with shunted hydrocephalus","volume":"90","author":"Bourgeois","year":"1999"},{"key":"b7-0330013","series-title":"Childs Nerv Syst","first-page":"286","article-title":"Peritoneal cerebrospinal fluid pseudocysts: a complication of ventriculoperitoneal shunts","volume":"4","author":"Burchianti","year":"1988"},{"issue":"4","key":"b8-0330013","series-title":"Neurosurg Focus","first-page":"e7","article-title":"Incidence and management of subdural hematoma\/hygroma with variable- and fixed-pressure differential valves: a randomized, controlled study of programmable compared with conventional valves","volume":"7","author":"Carmel","year":"1999"},{"key":"b9-0330013","series-title":"Pediatr Neurosurg","first-page":"63","article-title":"The long-term outlook for hydrocephalus in childhood. 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