{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:39:04Z","timestamp":1792809544671,"version":"4.5.0"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2]]},"abstract":"\n OBJECTIVE<\/jats:title>\n This investigation is aimed at gaining a better understanding of the factors that lead to mechanical failure of shunts used for the treatment of hydrocephalus, including shunt catheter-valve disconnection and shunt catheter fracture.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n To determine the root cause of mechanical failure, the authors created a benchtop mechanical model to mimic mechanical stressors on a shunt system. To test shunt fracture, cyclical loading on the catheter-valve connection site was tested with the shunt catheter held perpendicular to the valve. Standard methods were used to secure the catheter and valves with Nurolon. These commercial systems were compared to integrated catheters and valves (manufactured as one unit). To test complete separation\/disconnection of the shunt catheter and valve, a parallel displacement test was conducted using both Nurolon and silk sutures. Finally, the stiffness of the catheters was assessed. All mechanical investigations were conducted on shunts from two major shunt companies, assigned as either company A or company B.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Cyclical loading experiments found that shunts from company B fractured after a mean of 4936 \u00b1 1725 cycles (95% CI 2990\u20136890 cycles), while those of company A had not failed after 8000 cycles. The study of parallel displacement indicated complete disconnection of company B\u2019s shunt catheter-valve combination using Nurolon sutures after being stretched an average 32 \u00b1 5.68 mm (95% CI 25.6\u201338.4 mm), whereas company A\u2019s did not separate using either silk or Nurolon sutures. During the stiffness experiments, the catheters of company B had statistically significantly higher stiffness of 13.23 \u00b1 0.15 N compared to those of company A, with 6.16 \u00b1 0.29 N (p < 0.001).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Mechanical shunt failure from shunt catheter-valve disconnection or fracture is a significant cause of shunt failure. This study demonstrates, for the first time, a correlation between shunt catheters that are less mechanically stiff and those that are less likely to disconnect from the valve when outstretched and are also less likely to tear when held at an angle from the valve outlet. The authors propose an intervention to the standard of care wherein less stiff catheters are trialed to reduce disconnection.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2020.6.peds20454","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T02:08:40Z","timestamp":1605233320000},"page":"125-130","source":"Crossref","is-referenced-by-count":11,"title":["Investigation of ventriculoperitoneal shunt disconnection for hydrocephalus treatment"],"prefix":"10.3171","volume":"27","author":[{"given":"Sulmaz","family":"Zahedi","sequence":"first","affiliation":[{"name":"College of Medicine, Central Michigan University, Mount Pleasant, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miles","family":"Hudson","sequence":"additional","affiliation":[{"name":"School of Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard Justin","family":"Garling","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Gluski","sequence":"additional","affiliation":[{"name":"School of Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caden","family":"Nowak","sequence":"additional","affiliation":[{"name":"School of Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neena I.","family":"Marupudi","sequence":"additional","affiliation":[{"name":"School of Medicine,"},{"name":"Department of Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Begeman","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn A.","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering,"},{"name":"Department of Neurosurgery, and"},{"name":"Department of Chemical Engineering and Material Science, Wayne State University, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"10","key":"b1","series-title":"PLoS One","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0204926","article-title":"Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance","volume":"13","author":"Isaacs AM","year":"2018","unstructured":"Isaacs AM, Riva-Cambrin J, Yavin D, Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance. PLoS One. 2018;13(10):e0204926.10.1371\/journal.pone.020492630273390"},{"issue":"2","key":"b2","series-title":"Pediatr Neurol","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.pediatrneurol.2005.05.020","article-title":"Failure of cerebrospinal fluid shunts: Part I: Obstruction and mechanical failure","volume":"34","author":"Browd SR","year":"2006","unstructured":"Browd SR, Ragel BT, Gottfried ON, Kestle JRW. Failure of cerebrospinal fluid shunts: Part I: Obstruction and mechanical failure. Pediatr Neurol. 2006;34(2):83\u201392.10.1016\/j.pediatrneurol.2005.05.02016458818"},{"issue":"1","key":"b3","series-title":"J Neurol Neurosurg Psychiatry","first-page":"i17","article-title":"Hydrocephalus and shunts: what the neurologist should know","volume":"73","author":"Pople IK","year":"2002","unstructured":"Pople IK. Hydrocephalus and shunts: what the neurologist should know. J Neurol Neurosurg Psychiatry. 2002;73(1)(suppl 1):i17\u2013i22.12185257"},{"issue":"3","key":"b4","series-title":"BMC Surg","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/1471-2482-12-12","article-title":"Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage","volume":"12","author":"Wang YM","year":"2012","unstructured":"Wang YM, Lin YJ, Chuang MJ, Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage. BMC Surg. 2012;12(3):12.2276576510.1186\/1471-2482-12-12"},{"issue":"2","key":"b5","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1227\/01.neu.0000316268.05338.5b","article-title":"The surgical management of pediatric hydrocephalus","volume":"62","author":"Drake JM","year":"2008","unstructured":"Drake JM. The surgical management of pediatric hydrocephalus. Neurosurgery. 2008;62(2)(suppl 2):633\u2013642.1859644110.1227\/01.neu.0000316268.05338.5b"},{"issue":"1","key":"b6","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1227\/01.NEU.0000146206.40375.41","article-title":"Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment","volume":"56","author":"Patwardhan RV","year":"2005","unstructured":"Patwardhan RV, Nanda A. Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery. 2005;56(1):139\u2013145.10.1227\/01.NEU.0000146206.40375.4115617596"},{"issue":"2","key":"b7","series-title":"Can J Neurol Sci","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1017\/S0317167100033722","article-title":"Epidemiology and direct economic impact of hydrocephalus: a community based study","volume":"25","author":"Del Bigio MR","year":"1998","unstructured":"Del Bigio MR. Epidemiology and direct economic impact of hydrocephalus: a community based study. Can J Neurol Sci. 1998;25(2):123\u2013126.960413310.1017\/S0317167100033722"},{"issue":"2","key":"b8","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"131","DOI":"10.3171\/PED\/2008\/1\/2\/131","article-title":"Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths","volume":"1","author":"Simon TD","year":"2008","unstructured":"Simon TD, Riva-Cambrin J, Srivastava R, Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatr. 2008;1(2):131\u2013137.10.3171\/PED\/2008\/1\/2\/13118352782"},{"key":"b9","series-title":"Fluids Barriers CNS","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.1186\/1743-8454-6-S1-S42","article-title":"Are we implanting catheters that facilitate shunt failure?","volume":"6","author":"Black C","year":"2009","unstructured":"Black C, Resau J, West R, Are we implanting catheters that facilitate shunt failure? Fluids Barriers CNS. 2009;6:S42.10.1186\/1743-8454-6-S1-S42"},{"issue":"2","key":"b10","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"213","DOI":"10.3171\/2016.2.PEDS15531","article-title":"Toward a better understanding of the cellular basis for cerebrospinal fluid shunt obstruction: report on the construction of a bank of explanted hydrocephalus devices","volume":"18","author":"Hanak BW","year":"2016","unstructured":"Hanak BW, Ross EF, Harris CA, Toward a better understanding of the cellular basis for cerebrospinal fluid shunt obstruction: report on the construction of a bank of explanted hydrocephalus devices. J Neurosurg Pediatr. 2016;18(2):213\u2013223.10.3171\/2016.2.PEDS15531"},{"issue":"6","key":"b11","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1159\/000452840","article-title":"Cerebrospinal fluid shunting complications in children","volume":"52","author":"Hanak BW","year":"2017","unstructured":"Hanak BW, Bonow RH, Harris CA, Browd SR. Cerebrospinal fluid shunting complications in children. Pediatr Neurosurg. 2017;52(6):381\u2013400.10.1159\/00045284028249297"},{"issue":"10-11","key":"b12","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1007\/s003810000351","article-title":"CSF shunts 50 years on\u2014past, present and future","volume":"16","author":"Drake JM","year":"2000","unstructured":"Drake JM, Kestle JR, Tuli S. CSF shunts 50 years on\u2014past, present and future. Childs Nerv Syst. 2000;16(10-11):800\u2013804.10.1007\/s00381000035111151733"},{"issue":"2","key":"b13","series-title":"Exp Neurol","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.expneurol.2009.12.027","article-title":"Mechanical contributions to astrocyte adhesion using a novel in vitro model of catheter obstruction","volume":"222","author":"Harris CA","year":"2010","unstructured":"Harris CA, Resau JH, Hudson EA, Mechanical contributions to astrocyte adhesion using a novel in vitro model of catheter obstruction. Exp Neurol. 2010;222(2):204\u2013210.10.1016\/j.expneurol.2009.12.02720051241"},{"issue":"1","key":"b14","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1159\/000120557","article-title":"Mechanical complications in shunts","volume":"17","author":"Sainte-Rose C","year":"1991-1992","unstructured":"Sainte-Rose C, Piatt JH, Renier D, Mechanical complications in shunts. Pediatr Neurosurg. 1991-1992;17(1):2\u20139.10.1159\/000120557"},{"issue":"7","key":"b15","series-title":"J Oral Maxillofac Surg","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1016\/j.joms.2016.02.004","article-title":"Knot security\u2014How is it affected by suture technique, material, size, and number of throws?","volume":"74","author":"Silver E","year":"2016","unstructured":"Silver E, Wu R, Grady J, Song L. Knot security\u2014How is it affected by suture technique, material, size, and number of throws? J Oral Maxillofac Surg. 2016;74(7):1304\u20131312.10.1016\/j.joms.2016.02.00426979258"},{"issue":"3","key":"b16","series-title":"Plant Cell","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1105\/tpc.10.3.451","article-title":"Water transport activity of the plasma membrane aquaporin PM28A is regulated by phosphorylation","volume":"10","author":"Johansson I","year":"1998","unstructured":"Johansson I, Karlsson M, Shukla VK, Water transport activity of the plasma membrane aquaporin PM28A is regulated by phosphorylation. Plant Cell. 1998;10(3):451\u2013459.10.1105\/tpc.10.3.4519501117"},{"issue":"6","key":"b17","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1159\/000120549","article-title":"Disconnection as a cause of ventriculoperitoneal shunt malfunction in multicomponent shunt systems","volume":"16","author":"Aldrich EF","year":"1990-1991","unstructured":"Aldrich EF, Harmann P. Disconnection as a cause of ventriculoperitoneal shunt malfunction in multicomponent shunt systems. Pediatr Neurosurg. 1990-1991;16(6):309\u2013312.10.1159\/000120549"},{"issue":"4","key":"b18","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/BF00262852","article-title":"Occurrence and management of fractured peripheral catheters in CSF shunts","volume":"8","author":"Langmoen IA","year":"1992","unstructured":"Langmoen IA, Lundar T, Vatne K, Occurrence and management of fractured peripheral catheters in CSF shunts. Childs Nerv Syst. 1992;8(4):222\u2013225.139425610.1007\/BF00262852"},{"issue":"6","key":"b19","series-title":"Childs Brain","first-page":"321","article-title":"Complications of ventriculo-peritoneal shunting and a critical comparison of the three-piece and one-piece systems","volume":"3","author":"Raimondi AJ","year":"1977","unstructured":"Raimondi AJ, Robinson JS, Kuwawura K. Complications of ventriculo-peritoneal shunting and a critical comparison of the three-piece and one-piece systems. Childs Brain. 1977;3(6):321\u2013342."},{"key":"b20","article-title":"ISO 7197:2006 Neurosurgical implants\u2014Sterile, single-use hydrocephalus shunts and components","author":"International Organization for Standardization","unstructured":"International Organization for Standardization. ISO 7197:2006 Neurosurgical implants\u2014Sterile, single-use hydrocephalus shunts and components. Accessed August 3, 2020. https:\/\/www.iso.org\/standard\/38403.html"},{"key":"b21","article-title":"ASTM F647-94 (Reapproved 2014) Standard practice for evaluating and specifying implantable shunt assemblies for neurosurgical application","author":"FDA","year":"08\/14\/2015","unstructured":"FDA. ASTM F647-94 (Reapproved 2014) Standard practice for evaluating and specifying implantable shunt assemblies for neurosurgical application. 08\/14\/2015. Accessed August 3, 2020. https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfStandards\/detail.cfm?standard__identification_no=33268"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/27\/2\/article-p125.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/27\/2\/article-p125.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/27\/2\/article-p125.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:05:34Z","timestamp":1792807534000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/27\/2\/article-p125.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":21,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2020.6.peds20454","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2]]}}}