{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:48:42Z","timestamp":1788414522797,"version":"build-2803163510"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Placement of a cerebrospinal fluid diversion device (i.e., shunt) is a routine pediatric neurosurgical procedure, often performed in the first weeks of life for treatment of congenital hydrocephalus. In the postoperative period, shunt placement may be complicated by subdural, catheter tract, parenchymal, and intraventricular hemorrhages. The authors observed a subset of infants and neonates who developed multifocal intraparenchymal hemorrhages (MIPH) following shunt placement and sought to determine any predisposing perioperative variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A retrospective review of the electronic medical record at a tertiary-care children\u2019s hospital was performed for the period 1998\u20132015. Inclusion criteria consisted of shunt placement, age &lt; 30 days, and available pre- and postoperative brain imaging. The following data were collected and analyzed for each case: ventricular size ratios, laboratory values, clinical presentation, shunt and valve type, and operative timing and approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 121 neonates met the inclusion criteria for the study, and 11 patients (9.1%) had MIPH following shunt placement. The preoperative frontal and occipital horn ratio (FOR) was significantly higher in the patients with MIPH than in those without (0.65 vs 0.57, p &lt; 0.001). The change in FOR (\u2206FOR) after shunt placement was significantly greater in the MIPH group (0.14 vs 0.08, p = 0.04). Among neonates who developed MIPH, aqueductal stenosis was the most common etiology (45%). The type of shunt valve was associated with incidence of MIPH (p &lt; 0.001). Preoperative clinical parameters, including head circumference, bulging fontanelle, and coagulopathy, were not significantly associated with development of MIPH.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>MIPH represents an underrecognized complication of neonatal shunted hydrocephalus. Markers of severity of ventriculomegaly (FOR) and ventricular response to CSF diversion (\u2206FOR) were significantly associated with occurrence of MIPH. Choice of shunt and etiology of hydrocephalus were also significantly associated with MIPH. After adjusting for corrected age, etiology of hydrocephalus, and shunt setting, the authors found that \u2206FOR after shunting was still associated with MIPH. A prospective study of MIPH prevention strategies and assessment of possible implications for patient outcomes is needed.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.6.peds16481","type":"journal-article","created":{"date-parts":[[2017,9,8]],"date-time":"2017-09-08T13:55:44Z","timestamp":1504878944000},"page":"432-438","source":"Crossref","is-referenced-by-count":9,"title":["Frontal and occipital horn ratio is associated with multifocal intraparenchymal hemorrhages in neonatal shunted hydrocephalus"],"prefix":"10.3171","volume":"20","author":[{"given":"Soliman","family":"Oushy","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon J.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado; and"},{"name":"Child Health Research Biostatistical Core, Children\u2019s Hospital Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Palmer","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Colorado School of Medicine;"},{"name":"Child Health Research Biostatistical Core, Children\u2019s Hospital Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corbett","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas V.","family":"Stence","sequence":"additional","affiliation":[{"name":"Radiology, and"},{"name":"Radiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael H.","family":"Handler","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Mirsky","sequence":"additional","affiliation":[{"name":"Radiology, and"},{"name":"Radiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1007\/BF01410625","article-title":"Frequency and causes of shunt revisions in different cerebrospinal fluid shunt types","volume":"136","author":"Borgbjerg BM","year":"1995","unstructured":"Borgbjerg BM, Gjerris F, Albeck MJ, Hauerberg J, B\u00f8rgesen SE: Frequency and causes of shunt revisions in different cerebrospinal fluid shunt types. 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