{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:51:53Z","timestamp":1769388713878,"version":"3.49.0"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Indications for surgical treatment of hydrocephalus (HC) can vary across centers. The authors sought to investigate the frequencies of surgically treated HC disorders and to study variations in the practice of shunt surgery in Norway, a country with universal and free healthcare.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This is a nationwide registry\u2013based study using data from the Norwegian Patient Registry. Four neurosurgical centers serve exclusively in 4 defined geographic regions. All patients who underwent shunt surgery in Norway between January 1, 2008, and December 31, 2021, were included and regional differences and time trends were explored.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The national annual rate of shunt surgery in the study period was 6.0 per 100,000. A total of 4139 individuals (49.5% male) underwent primary shunt surgeries, and a total of 9262 operations including revision surgeries were performed. There were statistically significant regional differences between the 4 treating centers in Norway in terms of patients\u2019 age (median 61 years, range 53\u201365 years); mean annual rate of primary shunt surgery (5.1\u20137.6 per 100,000); annual rate of primary shunt surgery in patients of different age groups (0.9\u20131.2 in 0\u201317 years, 1.8\u20132.7 in 18\u201364 years, and 1.6\u20133.9 in \u2265 65 years); annual rate of revision surgeries (2.4\u20135.7 per 100,000); annual rate of primary surgery for communicating HC (0.7\u20132.0 per 100,000); annual rate of primary surgery for normal pressure HC (0.5\u20131.8 per 100,000); and annual rate of primary surgery for HC associated with cerebrovascular disease (0.5\u20132.0 per 100,000). There was significant variation in overall shunt surgeries during the study period (p = 0.026), and there was an overall decrease in revision surgeries over time (p &lt; 0.001). There appears to be a homogenization of revision surgeries over time.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>There are significant and large practice variations in the surgical management of HC in Norway. There are significant differences between regions, particularly in terms of rates of shunt surgery for some diagnoses (communicating HC, normal pressure HC, and HC associated with cerebrovascular disease) as well as revision rates.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.12.jns222083","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T16:04:07Z","timestamp":1675440247000},"page":"892-900","source":"Crossref","is-referenced-by-count":5,"title":["Epidemiology and practice variations of shunt surgery for hydrocephalus: a nationwide registry\u2013based study"],"prefix":"10.3171","volume":"139","author":[{"given":"Nadia","family":"Mansoor","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, St. Olavs University Hospital, Trondheim; and"},{"name":"Departments of Neuroscience and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sasha","family":"Gulati","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Olavs University Hospital, Trondheim; and"},{"name":"Departments of Neuroscience and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oddrun A.","family":"Fredriksli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Olavs University Hospital, Trondheim; and"},{"name":"Departments of Neuroscience and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d8yvind","family":"Salvesen","sequence":"additional","affiliation":[{"name":"Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ole","family":"Solheim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Olavs University Hospital, Trondheim; and"},{"name":"Departments of Neuroscience and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"Brain Behav","first-page":"e2390","article-title":"Shunt complications and revisions in children: a retrospective single institution study","volume":"11","author":"Mansoor N","year":"2021","unstructured":"Mansoor N, Solheim O, Fredriksli OA, Gulati S. 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Forty years of shunt surgery at Rigshospitalet, Denmark: a retrospective study comparing past and present rates and causes of revision and infection. BMJ Open. 2017;7(1):e013389."},{"issue":"3","key":"b4","series-title":"Neurosurgery","first-page":"557","article-title":"Ventriculoperitoneal shunt complications in California: 1990 to 2000","volume":"61","author":"Wu Y","year":"2007","unstructured":"Wu Y, Green NL, Wrensch MR, Zhao S, Gupta N. Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery. 2007;61(3):557\u2013563."},{"issue":"1","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"40","article-title":"Have we made progress in preventing shunt failure? A critical analysis","volume":"1","author":"Stein SC","year":"2008","unstructured":"Stein SC, Guo W. Have we made progress in preventing shunt failure? A critical analysis. 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