{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:30:32Z","timestamp":1783776632287,"version":"3.55.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,11]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Despite significant advances in the medical field and shunt technology, shunt malfunction remains a nightmare of pediatric neurosurgeons. In this setting, the ability to preoperatively predict the probability of shunt malfunction is quite compelling. The authors have compared the preoperative radiological findings in obstructive hydrocephalus and the subsequent clinical course of the patient to determine any association with overall shunt outcome.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This retrospective study included all pediatric patients (age < 18 years) who had undergone ventriculoperitoneal shunt insertion for obstructive hydrocephalus. Linear measurements were taken from pre- and postoperative CT or MRI studies to calculate different indices and ratios including Evans' index, frontal horn index (FHI), occipital horn index (OHI), frontooccipital horn ratio (FOHR), and frontooccipital horn index ratio (FOIR). Other morphological features such as bi- or triventriculomegaly, right-left ventricular symmetry, and periventricular lucency (PVL) were also noted. The primary clinical outcomes that were reviewed included the need for shunt revision, time interval to first shunt revision, frequency of shunt revisions, and revision-free survival.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 121 patients were eligible for the analysis. Nearly half of the patients (47.9%) required shunt revision. The presence of PVL was associated with lower revision rates than those in others (39.4% vs 58.2%, p = 0.03). None of the preoperative radiological indices or ratios showed any correlation with shunt revision. Nearly half of the patients with shunt revision required early revision (< 90 days of primary surgery). The reduction in the FOHR was high in patients who required early shunt revision (20.16% in patients with early shunt revision vs 6.4% in patients with late shunt revision, p = 0.009). Nearly half of the patients (48.3%) requiring shunt revision ultimately needed more than one revision procedure. Greater occipital horn dilation on preoperative images was associated with a lower frequency of shunt revision, as dictated by a high OHI and a low FOIR in patients with a single shunt revision as compared with those in patients who required multiple shunt revisions (p = 0.029 and 0.009, respectively). The mean follow-up was 49.9 months. Age was a significant factor affecting shunt revision\u2013free survival. Patients younger than 6 months of age had significantly less revision-free survival than the patients older than 6 months (median survival of 10.1 vs 94.1 months, p = 0.004).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Preoperative radiological linear indices and ratios do not predict the likelihood of subsequent shunt malfunction. However, patients who required early shunt revision tended to have greater reductions in ventricular volumes on postoperative images. Therefore a greater reduction in ventricular volume is not actually desirable, and a ventricular volume high enough to reduce intracranial pressure is instead to be aimed at for long-term shunt compliance.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.8.focus16263","type":"journal-article","created":{"date-parts":[[2016,11,1]],"date-time":"2016-11-01T03:38:03Z","timestamp":1477971483000},"page":"E4","source":"Crossref","is-referenced-by-count":12,"title":["Role of radiological parameters in predicting overall shunt outcome after ventriculoperitoneal shunt insertion in pediatric patients with obstructive hydrocephalus"],"prefix":"10.3171","volume":"41","author":[{"given":"Devi Prasad","family":"Patra","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyamal C.","family":"Bir","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanmoy K.","family":"Maiti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piyush","family":"Kalakoti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Cuellar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharat","family":"Guthikonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Notarianni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Nanda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16263","series-title":"Pediatr Emerg Care","first-page":"435","article-title":"Radiographic evaluation of pediatric cerebrospinal fluid shunt malfunction in the emergency setting","volume":"31","author":"Boyle","year":"2015"},{"key":"b2-focus16263","series-title":"Pediatrics","first-page":"e47","article-title":"Comparison of rapid cranial MRI to CT for ventricular shunt malfunction","volume":"134","author":"Boyle","year":"2014"},{"key":"b3-focus16263","series-title":"Pediatr Neurol","first-page":"83","article-title":"Failure of cerebrospinal fluid shunts: part I: Obstruction and mechanical failure","volume":"34","author":"Browd","year":"2006"},{"key":"b4-focus16263","series-title":"Pediatr Neurosurg","first-page":"73","article-title":"Neuroendoscopic third ventriculostomy in patients less than 1 year old","volume":"29","author":"Buxton","year":"1998"},{"key":"b5-focus16263","series-title":"J Ultrasound Med","first-page":"263","article-title":"Postnatal outcome of fetuses with the prenatal diagnosis of asymmetric hydrocephalus","volume":"20","author":"Durfee","year":"2001"},{"issue":"2 Suppl","key":"b6-focus16263","series-title":"J Neurosurg","first-page":"147","article-title":"The use of quick-brain magnetic resonance imaging in the evaluation of shunt-treated hydrocephalus","volume":"101","author":"Iskandar","year":"2004"},{"key":"b7-focus16263","series-title":"Pediatr Neurosurg","first-page":"17","article-title":"Frontal and occipital horn width ratio for the evaluation of small and asymmetrical ventricles","volume":"39","author":"Jamous","year":"2003"},{"key":"b8-focus16263","series-title":"Childs Nerv Syst","first-page":"161","article-title":"Surgical outcome of pediatric hydrocephalus treated by endoscopic III ventriculostomy: prognostic factors and interpretation of postoperative neuroimaging","volume":"16","author":"Kim","year":"2000"},{"key":"b9-focus16263","series-title":"J Neurosurg","first-page":"915","article-title":"Imaging correlates of successful endoscopic third ventriculostomy","volume":"92","author":"Kulkarni","year":"2000"},{"key":"b10-focus16263","series-title":"J Neurosurg Pediatr","first-page":"125","article-title":"Volumetric brain analysis in neurosurgery: Part 2. Brain and CSF volumes discriminate neurocognitive outcomes in hydrocephalus","volume":"15","author":"Mandell","year":"2015"},{"key":"b11-focus16263","series-title":"J Comput Assist Tomogr","first-page":"204","article-title":"Periventricular lucency in computed tomography of hydrocephalus and cerebral atrophy","volume":"4","author":"Mori","year":"1980"},{"issue":"Suppl 1","key":"b12-focus16263","series-title":"J Neurosurg Pediatr","first-page":"77","article-title":"Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 10: Change in ventricle size as a measurement of effective treatment of hydrocephalus","volume":"14","author":"Nikas","year":"2014"},{"key":"b13-focus16263","series-title":"J Neurosurg Pediatr","first-page":"547","article-title":"Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions","volume":"4","author":"Notarianni","year":"2009"},{"key":"b14-focus16263","series-title":"Pediatr Neurosurg","first-page":"245","article-title":"Frontal and occipital horn ratio: A linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus","volume":"29","author":"O'Hayon","year":"1998"},{"key":"b15-focus16263","series-title":"Neurosurgery","first-page":"139","article-title":"Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment","volume":"56","author":"Patwardhan","year":"2005"},{"key":"b16-focus16263","series-title":"Pediatr Neurosurg","first-page":"233","article-title":"A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience","volume":"19","author":"Piatt","year":"1993"},{"key":"b17-focus16263","series-title":"J Neurosurg Pediatr","first-page":"547","article-title":"The accuracy of linear indices of ventricular volume in pediatric hydrocephalus: technical note","volume":"15","author":"Ragan","year":"2015"},{"key":"b18-focus16263","series-title":"J Neurosurg Pediatr","first-page":"382","article-title":"Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study","volume":"17","author":"Riva-Cambrin","year":"2016"},{"key":"b19-focus16263","series-title":"J Neurosurg Pediatr","first-page":"160","article-title":"Utility of computed tomography or magnetic resonance imaging evaluation of ventricular morphology in suspected cerebrospinal fluid shunt malfunction","volume":"14","author":"Sellin","year":"2014"},{"key":"b20-focus16263","series-title":"Childs Nerv Syst","first-page":"834","article-title":"Changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy","volume":"20","author":"St George","year":"2004"},{"key":"b21-focus16263","series-title":"J Neurosurg Pediatr","first-page":"564","article-title":"Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda","volume":"4","author":"Warf","year":"2009"},{"key":"b22-focus16263","series-title":"J Neurosurg Pediatr","first-page":"420","article-title":"Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation","volume":"15","author":"Yue","year":"2015"},{"key":"b1-focus16263","series-title":"Pediatr Emerg Care","first-page":"435","article-title":"Radiographic evaluation of pediatric cerebrospinal fluid shunt malfunction in the emergency setting","volume":"31","author":"Boyle","year":"2015"},{"key":"b2-focus16263","series-title":"Pediatrics","first-page":"e47","article-title":"Comparison of rapid cranial MRI to CT for ventricular shunt malfunction","volume":"134","author":"Boyle","year":"2014"},{"key":"b3-focus16263","series-title":"Pediatr Neurol","first-page":"83","article-title":"Failure of cerebrospinal fluid shunts: part I: Obstruction and mechanical failure","volume":"34","author":"Browd","year":"2006"},{"key":"b4-focus16263","series-title":"Pediatr Neurosurg","first-page":"73","article-title":"Neuroendoscopic third ventriculostomy in patients less than 1 year old","volume":"29","author":"Buxton","year":"1998"},{"key":"b5-focus16263","series-title":"J Ultrasound Med","first-page":"263","article-title":"Postnatal outcome of fetuses with the prenatal diagnosis of asymmetric hydrocephalus","volume":"20","author":"Durfee","year":"2001"},{"issue":"2 Suppl","key":"b6-focus16263","series-title":"J Neurosurg","first-page":"147","article-title":"The use of quick-brain magnetic resonance imaging in the evaluation of shunt-treated hydrocephalus","volume":"101","author":"Iskandar","year":"2004"},{"key":"b7-focus16263","series-title":"Pediatr Neurosurg","first-page":"17","article-title":"Frontal and occipital horn width ratio for the evaluation of small and asymmetrical ventricles","volume":"39","author":"Jamous","year":"2003"},{"key":"b8-focus16263","series-title":"Childs Nerv Syst","first-page":"161","article-title":"Surgical outcome of pediatric hydrocephalus treated by endoscopic III ventriculostomy: prognostic factors and interpretation of postoperative neuroimaging","volume":"16","author":"Kim","year":"2000"},{"key":"b9-focus16263","series-title":"J Neurosurg","first-page":"915","article-title":"Imaging correlates of successful endoscopic third ventriculostomy","volume":"92","author":"Kulkarni","year":"2000"},{"key":"b10-focus16263","series-title":"J Neurosurg Pediatr","first-page":"125","article-title":"Volumetric brain analysis in neurosurgery: Part 2. Brain and CSF volumes discriminate neurocognitive outcomes in hydrocephalus","volume":"15","author":"Mandell","year":"2015"},{"key":"b11-focus16263","series-title":"J Comput Assist Tomogr","first-page":"204","article-title":"Periventricular lucency in computed tomography of hydrocephalus and cerebral atrophy","volume":"4","author":"Mori","year":"1980"},{"issue":"Suppl 1","key":"b12-focus16263","series-title":"J Neurosurg Pediatr","first-page":"77","article-title":"Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 10: Change in ventricle size as a measurement of effective treatment of hydrocephalus","volume":"14","author":"Nikas","year":"2014"},{"key":"b13-focus16263","series-title":"J Neurosurg Pediatr","first-page":"547","article-title":"Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions","volume":"4","author":"Notarianni","year":"2009"},{"key":"b14-focus16263","series-title":"Pediatr Neurosurg","first-page":"245","article-title":"Frontal and occipital horn ratio: A linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus","volume":"29","author":"O'Hayon","year":"1998"},{"key":"b15-focus16263","series-title":"Neurosurgery","first-page":"139","article-title":"Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment","volume":"56","author":"Patwardhan","year":"2005"},{"key":"b16-focus16263","series-title":"Pediatr Neurosurg","first-page":"233","article-title":"A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience","volume":"19","author":"Piatt","year":"1993"},{"key":"b17-focus16263","series-title":"J Neurosurg Pediatr","first-page":"547","article-title":"The accuracy of linear indices of ventricular volume in pediatric hydrocephalus: technical note","volume":"15","author":"Ragan","year":"2015"},{"key":"b18-focus16263","series-title":"J Neurosurg Pediatr","first-page":"382","article-title":"Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study","volume":"17","author":"Riva-Cambrin","year":"2016"},{"key":"b19-focus16263","series-title":"J Neurosurg Pediatr","first-page":"160","article-title":"Utility of computed tomography or magnetic resonance imaging evaluation of ventricular morphology in suspected cerebrospinal fluid shunt malfunction","volume":"14","author":"Sellin","year":"2014"},{"key":"b20-focus16263","series-title":"Childs Nerv Syst","first-page":"834","article-title":"Changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy","volume":"20","author":"St George","year":"2004"},{"key":"b21-focus16263","series-title":"J Neurosurg Pediatr","first-page":"564","article-title":"Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda","volume":"4","author":"Warf","year":"2009"},{"key":"b22-focus16263","series-title":"J Neurosurg Pediatr","first-page":"420","article-title":"Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation","volume":"15","author":"Yue","year":"2015"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/5\/article-pE4.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/5\/article-pE4.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/5\/article-pE4.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T08:58:27Z","timestamp":1779526707000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/5\/article-pE4.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11]]},"references-count":44,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2016.8.focus16263","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11]]}}}