{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T02:26:22Z","timestamp":1794018382150,"version":"4.8.0"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Children whose ventricles do not change during shunt malfunction present a diagnostic dilemma. This study was performed to identify risk factors for unchanged ventricular size at shunt malfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective 1:1 age-matched case-control study identified children with shunted hydrocephalus who underwent shunt revision with intraoperative evidence of malfunction at one of the three participating institutions from 1997 to 2019. Cases were defined as patients with a change of &lt; 0.05 in the frontal\u2013occipital horn ratio (FOR) between malfunction and baseline, and controls included patients with FOR changes \u2265 0.05. The presence of infection, abdominal pseudocyst, pseudomeningocele, or wound drainage and lack of baseline cranial imaging at the time of malfunction warranted exclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 450 included patients, 60% were male, 73% were Caucasian, and 67% had an occipital shunt. The median age was 4.3 (IQR 0.97\u20139.21) years at malfunction. On univariable analysis, unchanged ventricles at malfunction were associated with a frontal shunt (41% vs 28%, p &lt; 0.001), programmable valve (17% vs 9%, p = 0.011), nonsiphoning shunt (85% vs 66%, p &lt; 0.001), larger baseline FOR (0.44 \u00b1 0.12 vs 0.38 \u00b1 0.11, p &lt; 0.001), no prior shunt infection (87% vs 76%, p = 0.003), and no prior shunt revisions (68% vs 52%, p &lt; 0.001). On multivariable analysis with collinear variables removed, patients with a frontal shunt (OR 1.67, 95% CI 1.08\u20132.70, p = 0.037), programmable valve (OR 2.63, 95% CI 1.32\u20135.26, p = 0.007), nonsiphoning shunt at malfunction (OR 2.76, 95% CI 1.63\u20134.67, p &lt; 0.001), larger baseline FOR (OR 3.13, 95% CI 2.21\u20134.43, p &lt; 0.001), and no prior shunt infection (OR 2.34, 95% CI 1.27\u20134.30, p = 0.007) were more likely to have unchanged ventricles at malfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In a multicenter cohort of children with shunt malfunction, those with a frontal shunt, programmable valve, nonsiphoning shunt, baseline large ventricles, and no prior shunt infection were more likely than others to have unchanged ventricles at shunt failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2021.6.peds2125","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T07:22:09Z","timestamp":1632468129000},"page":"703-709","source":"Crossref","is-referenced-by-count":6,"title":["Risk factors for unchanged ventricles during pediatric shunt malfunction"],"prefix":"10.3171","volume":"28","author":[{"given":"Rebecca A.","family":"Reynolds","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville;"},{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranbir","family":"Ahluwalia","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Krishnan","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaclyn","family":"Lee","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond P.","family":"Waldrop","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham School of Medicine, Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Guidry","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid C.","family":"Hengartner","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"McCroskey","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Alabama at Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Arynchyna","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Alabama at Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Staulcup","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Chen","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"},{"name":"Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd C.","family":"Hankinson","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora, Colorado;"},{"name":"Department of Neurological Surgery, Children\u2019s Hospital Colorado, Aurora, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Alabama at Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chevis N.","family":"Shannon","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville;"},{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Naftel","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville;"},{"name":"Surgical Outcomes Center for Kids, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"10","key":"b1","series-title":"PLoS One","doi-asserted-by":"publisher","first-page":"e0204926","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, Hockley A, Pringsheim TM, Jette N,  Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance. 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