{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:51Z","timestamp":1787025771212,"version":"build-2736575974"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The traditional freehand insertion of a ventricular catheter using surface anatomical landmarks is a basic procedure for neurosurgeons. However, this procedure involves considerable uncertainty and frequently requires multiple placement attempts. This also periodically results in improper positioning of the catheter tip. The aim of this study was to evaluate the accuracy of ventricular catheter insertion using real-time ultrasound images acquired with a burr hole\u2013compatible transducer and to compare it with freehand insertion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective cohort study included all patients at a single institution who underwent a ventricular catheter insertion operation, including external ventricular drainage, ventriculoperitoneal shunt placement, and Ommaya reservoir insertion through a new burr hole, between January 2015 and March 2022. The data collected for each patient included age, sex, diagnosis, antiplatelet or anticoagulant use within 24 hours before or after the procedure, use of intraoperative real-time ultrasound with a burr hole\u2013compatible transducer, site and side of the ventricular catheter placement, number of attempts required to achieve successful insertion, postoperative parenchymal bleeding, and symptomatic complications related to inaccurate catheter insertion. The Evans index was acquired from preoperative CT images, and the accuracy of ventricular catheter placement was evaluated using postoperative CT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 136 procedures were included in this study; 81 ventricular catheters were inserted using the freehand technique, and 55 were inserted using the real-time ultrasound technique. The number of catheter placement attempts was significantly lower using the real-time ultrasound technique than the freehand technique (p &lt; 0.001), and the accuracy of the real-time ultrasound technique was significantly higher (p &lt; 0.001). The difference in accuracy between the ultrasound and freehand techniques was augmented in posterior horn punctures (100% and 74.1%, respectively, p = 0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The real-time ultrasound-guided ventricular catheter insertion technique is significantly more accurate than the traditional surface anatomical landmark\u2013based freehand technique and results in a reduced number of puncture attempts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.12.jns241625","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T03:41:56Z","timestamp":1743824516000},"page":"127-134","source":"Crossref","is-referenced-by-count":4,"title":["Accurate insertion of a ventricular catheter using intraoperative real-time ultrasound imaging with a burr hole\u2013compatible transducer"],"prefix":"10.3171","volume":"143","author":[{"given":"Noritaka","family":"Sano","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui; and"},{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadaharu","family":"Torikoshi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Kitahara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Hayase","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Surg Neurol","first-page":"375","article-title":"Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters","volume":"59","author":"Villavicencio AT","year":"2003","unstructured":"Villavicencio AT, Leveque JC, McGirt MJ, Hopkins JS, Fuchs HE, George TM. Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters. Surg Neurol. 2003;59(5):375\u2013380."},{"issue":"1","key":"b2","series-title":"J Neurosurg","first-page":"66","article-title":"Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation","volume":"119","author":"Wilson TJ","year":"2013","unstructured":"Wilson TJ, Stetler WR Jr, Al-Holou WN, Sullivan SE. Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation. J Neurosurg. 2013;119(1):66\u201370."},{"issue":"5","key":"b3","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Real-time ultrasound-guided external ventricular drain placement: technical note","volume":"43","author":"Manfield JH","year":"2017","unstructured":"Manfield JH, Yu KKH. Real-time ultrasound-guided external ventricular drain placement: technical note. Neurosurg Focus. 2017;43(5):E5."},{"issue":"1","key":"b4","series-title":"Sci Rep","first-page":"11525","article-title":"The accuracy and safety of intraoperative ultrasound-guided external ventricular drainage in intraventricular hemorrhage","volume":"13","author":"Zhang L","year":"2023","unstructured":"Zhang L, Mu Z, Shen G, Yang M. The accuracy and safety of intraoperative ultrasound-guided external ventricular drainage in intraventricular hemorrhage. Sci Rep. 2023;13(1):11525."},{"issue":"3","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"513","article-title":"sEVD\u2014smartphone-navigated placement of external ventricular drains","volume":"162","author":"Eisenring CV","year":"2020","unstructured":"Eisenring CV, Burn F, Baumann M,  sEVD\u2014smartphone-navigated placement of external ventricular drains. Acta Neurochir (Wien). 2020;162(3):513\u2013521."},{"issue":"1","key":"b6","series-title":"J Neurosurg","first-page":"304","article-title":"The relative efficacy of 3 different freehand frontal ventriculostomy trajectories: a prospective neuronavigation-assisted simulation study","volume":"126","author":"Kirkman MA","year":"2017","unstructured":"Kirkman MA, Muirhead W, Sevdalis N. The relative efficacy of 3 different freehand frontal ventriculostomy trajectories: a prospective neuronavigation-assisted simulation study. J Neurosurg. 2017;126(1):304\u2013311."},{"issue":"4","key":"b7","series-title":"Neurosurgery","first-page":"985","article-title":"Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study","volume":"68","author":"Korinek AM","year":"2011","unstructured":"Korinek AM, Fulla-Oller L, Boch AL, Golmard JL, Hadiji B, Puybasset L. Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study. Neurosurgery. 2011;68(4):985\u2013995."},{"issue":"1 Suppl 1","key":"b8","series-title":"Neurosurgery","first-page":"ONS162","article-title":"Safety and accuracy of bedside external ventricular drain placement","volume":"63","author":"Kakarla UK","year":"2008","unstructured":"Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF. Safety and accuracy of bedside external ventricular drain placement. Neurosurgery. 2008;63(1 Suppl 1):ONS162\u2013ONS167."},{"issue":"1","key":"b9","series-title":"J Neurosurg","first-page":"88","article-title":"Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans","volume":"108","author":"Huyette DR","year":"2008","unstructured":"Huyette DR, Turnbow BJ, Kaufman C, Vaslow DF, Whiting BB, Oh MY. Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans. J Neurosurg. 2008;108(1):88\u201391."},{"key":"b10","series-title":"Trials","first-page":"478","article-title":"Guided (VENTRI-GUIDE) versus freehand ventriculostomy: study protocol for a randomized controlled trial","volume":"15","author":"Sarrafzadeh A","year":"2014","unstructured":"Sarrafzadeh A, Smoll N, Schaller K. Guided (VENTRI-GUIDE) versus freehand ventriculostomy: study protocol for a randomized controlled trial. Trials. 2014;15:478."},{"key":"b11","series-title":"J Clin Neurosci","first-page":"44","article-title":"Stereotactic catheter placement for Ommaya reservoirs","volume":"27","author":"Kennedy BC","year":"2016","unstructured":"Kennedy BC, Brown LT, Komotar RJ, McKhann GMII. Stereotactic catheter placement for Ommaya reservoirs. J Clin Neurosci. 2016;27:44\u201347."},{"issue":"4","key":"b12","series-title":"J Neurosurg","first-page":"1268","article-title":"Image guidance and improved accuracy of external ventricular drain tip position particularly in patients with small ventricles","volume":"130","author":"Shtaya A","year":"2018","unstructured":"Shtaya A, Roach J, Sadek AR, Gaastra B, Hempenstall J, Bulters D. Image guidance and improved accuracy of external ventricular drain tip position particularly in patients with small ventricles. J Neurosurg. 2018;130(4):1268\u20131273."},{"issue":"4","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"393","article-title":"Ultrasound stylet for non-image-guided ventricular catheterization","volume":"16","author":"Coulson NK","year":"2015","unstructured":"Coulson NK, Chiarelli PA, Su DK,  Ultrasound stylet for non-image-guided ventricular catheterization. J Neurosurg Pediatr. 2015;16(4):393\u2013401."},{"issue":"3-4","key":"b14","series-title":"World Neurosurg","first-page":"536.e5","article-title":"Three-dimensional ultrasound-guided placement of ventricular catheters","volume":"82","author":"Jakola AS","year":"2014","unstructured":"Jakola AS, Reinertsen I, Selbekk T,  Three-dimensional ultrasound-guided placement of ventricular catheters. World Neurosurg. 2014;82(3-4):536.e5\u2013536.e9."},{"issue":"2","key":"b15","series-title":"J Neurosurg","first-page":"284","article-title":"Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial","volume":"98","author":"Kestle JR","year":"2003","unstructured":"Kestle JR, Drake JM, Cochrane DD,  Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg. 2003;98(2):284\u2013290."},{"issue":"7","key":"b16","series-title":"Neurol Med Chir (Tokyo).","first-page":"545","article-title":"Hemorrhage rates associated with two methods of ventriculostomy: external ventricular drainage vs. ventriculoperitoneal shunt procedure","volume":"54","author":"Ko JK","year":"2014","unstructured":"Ko JK, Cha SH, Choi BK, Lee JI, Yun EY, Choi CH. Hemorrhage rates associated with two methods of ventriculostomy: external ventricular drainage vs. ventriculoperitoneal shunt procedure. Neurol Med Chir (Tokyo). 2014;54(7):545-551."},{"issue":"1","key":"b17","series-title":"Neurocrit Care","first-page":"23","article-title":"The incidence of catheter tract hemorrhage and catheter placement accuracy in the CLEAR III trial","volume":"29","author":"M\u00fcller A","year":"2018","unstructured":"M\u00fcller A, Mould WA, Freeman WD,  The incidence of catheter tract hemorrhage and catheter placement accuracy in the CLEAR III trial. Neurocrit Care. 2018;29(1):23\u201332."},{"issue":"4","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"755","article-title":"Accuracy and complication rates of external ventricular drain placement with twist drill and bolt system versus standard trephine and tunnelation: a retrospective population-based study","volume":"162","author":"Mansoor N","year":"2020","unstructured":"Mansoor N, Madsbu MA, Mansoor NM,  Accuracy and complication rates of external ventricular drain placement with twist drill and bolt system versus standard trephine and tunnelation: a retrospective population-based study. Acta Neurochir (Wien). 2020;162(4):755\u2013761."},{"issue":"2","key":"b19","series-title":"Neurocrit Care","first-page":"255","article-title":"Strategic placement of bedside ventriculostomies using ultrasound image guidance: report of three cases","volume":"17","author":"Phillips SB","year":"2012","unstructured":"Phillips SB, Gates M, Krishnamurthy S. Strategic placement of bedside ventriculostomies using ultrasound image guidance: report of three cases. Neurocrit Care. 2012;17(2):255\u2013259."},{"issue":"11","key":"b20","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1248","article-title":"Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients","volume":"80","author":"Farahmand D","year":"2009","unstructured":"Farahmand D, Hilmarsson H, H\u00f6gfeldt M, Tisell M. Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients. J Neurol Neurosurg Psychiatry. 2009;80(11):1248\u20131253."},{"issue":"7","key":"b21","series-title":"Acta Neurochir (Wien)","first-page":"1991","article-title":"CSF shunt valve occlusion\u2014does CSF protein and cell count matter?","volume":"163","author":"Kaestner S","year":"2021","unstructured":"Kaestner S, Sani R, Graf K, Uhl E, Godau J, Deinsberger W. CSF shunt valve occlusion\u2014does CSF protein and cell count matter?. Acta Neurochir (Wien). 2021;163(7):1991\u20131996."},{"issue":"5","key":"b1","series-title":"Surg Neurol","first-page":"375","article-title":"Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters","volume":"59","author":"Villavicencio AT","year":"2003","unstructured":"Villavicencio AT, Leveque JC, McGirt MJ, Hopkins JS, Fuchs HE, George TM. Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters. Surg Neurol. 2003;59(5):375\u2013380."},{"issue":"1","key":"b2","series-title":"J Neurosurg","first-page":"66","article-title":"Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation","volume":"119","author":"Wilson TJ","year":"2013","unstructured":"Wilson TJ, Stetler WR Jr, Al-Holou WN, Sullivan SE. Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation. J Neurosurg. 2013;119(1):66\u201370."},{"issue":"5","key":"b3","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Real-time ultrasound-guided external ventricular drain placement: technical note","volume":"43","author":"Manfield JH","year":"2017","unstructured":"Manfield JH, Yu KKH. Real-time ultrasound-guided external ventricular drain placement: technical note. Neurosurg Focus. 2017;43(5):E5."},{"issue":"1","key":"b4","series-title":"Sci Rep","first-page":"11525","article-title":"The accuracy and safety of intraoperative ultrasound-guided external ventricular drainage in intraventricular hemorrhage","volume":"13","author":"Zhang L","year":"2023","unstructured":"Zhang L, Mu Z, Shen G, Yang M. The accuracy and safety of intraoperative ultrasound-guided external ventricular drainage in intraventricular hemorrhage. Sci Rep. 2023;13(1):11525."},{"issue":"3","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"513","article-title":"sEVD\u2014smartphone-navigated placement of external ventricular drains","volume":"162","author":"Eisenring CV","year":"2020","unstructured":"Eisenring CV, Burn F, Baumann M,  sEVD\u2014smartphone-navigated placement of external ventricular drains. Acta Neurochir (Wien). 2020;162(3):513\u2013521."},{"issue":"1","key":"b6","series-title":"J Neurosurg","first-page":"304","article-title":"The relative efficacy of 3 different freehand frontal ventriculostomy trajectories: a prospective neuronavigation-assisted simulation study","volume":"126","author":"Kirkman MA","year":"2017","unstructured":"Kirkman MA, Muirhead W, Sevdalis N. The relative efficacy of 3 different freehand frontal ventriculostomy trajectories: a prospective neuronavigation-assisted simulation study. J Neurosurg. 2017;126(1):304\u2013311."},{"issue":"4","key":"b7","series-title":"Neurosurgery","first-page":"985","article-title":"Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study","volume":"68","author":"Korinek AM","year":"2011","unstructured":"Korinek AM, Fulla-Oller L, Boch AL, Golmard JL, Hadiji B, Puybasset L. Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study. Neurosurgery. 2011;68(4):985\u2013995."},{"issue":"1 Suppl 1","key":"b8","series-title":"Neurosurgery","first-page":"ONS162","article-title":"Safety and accuracy of bedside external ventricular drain placement","volume":"63","author":"Kakarla UK","year":"2008","unstructured":"Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF. Safety and accuracy of bedside external ventricular drain placement. Neurosurgery. 2008;63(1 Suppl 1):ONS162\u2013ONS167."},{"issue":"1","key":"b9","series-title":"J Neurosurg","first-page":"88","article-title":"Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans","volume":"108","author":"Huyette DR","year":"2008","unstructured":"Huyette DR, Turnbow BJ, Kaufman C, Vaslow DF, Whiting BB, Oh MY. Accuracy of the freehand pass technique for ventriculostomy catheter placement: retrospective assessment using computed tomography scans. J Neurosurg. 2008;108(1):88\u201391."},{"key":"b10","series-title":"Trials","first-page":"478","article-title":"Guided (VENTRI-GUIDE) versus freehand ventriculostomy: study protocol for a randomized controlled trial","volume":"15","author":"Sarrafzadeh A","year":"2014","unstructured":"Sarrafzadeh A, Smoll N, Schaller K. Guided (VENTRI-GUIDE) versus freehand ventriculostomy: study protocol for a randomized controlled trial. Trials. 2014;15:478."},{"key":"b11","series-title":"J Clin Neurosci","first-page":"44","article-title":"Stereotactic catheter placement for Ommaya reservoirs","volume":"27","author":"Kennedy BC","year":"2016","unstructured":"Kennedy BC, Brown LT, Komotar RJ, McKhann GMII. Stereotactic catheter placement for Ommaya reservoirs. J Clin Neurosci. 2016;27:44\u201347."},{"issue":"4","key":"b12","series-title":"J Neurosurg","first-page":"1268","article-title":"Image guidance and improved accuracy of external ventricular drain tip position particularly in patients with small ventricles","volume":"130","author":"Shtaya A","year":"2018","unstructured":"Shtaya A, Roach J, Sadek AR, Gaastra B, Hempenstall J, Bulters D. Image guidance and improved accuracy of external ventricular drain tip position particularly in patients with small ventricles. J Neurosurg. 2018;130(4):1268\u20131273."},{"issue":"4","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"393","article-title":"Ultrasound stylet for non-image-guided ventricular catheterization","volume":"16","author":"Coulson NK","year":"2015","unstructured":"Coulson NK, Chiarelli PA, Su DK,  Ultrasound stylet for non-image-guided ventricular catheterization. J Neurosurg Pediatr. 2015;16(4):393\u2013401."},{"issue":"3-4","key":"b14","series-title":"World Neurosurg","first-page":"536.e5","article-title":"Three-dimensional ultrasound-guided placement of ventricular catheters","volume":"82","author":"Jakola AS","year":"2014","unstructured":"Jakola AS, Reinertsen I, Selbekk T,  Three-dimensional ultrasound-guided placement of ventricular catheters. World Neurosurg. 2014;82(3-4):536.e5\u2013536.e9."},{"issue":"2","key":"b15","series-title":"J Neurosurg","first-page":"284","article-title":"Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial","volume":"98","author":"Kestle JR","year":"2003","unstructured":"Kestle JR, Drake JM, Cochrane DD,  Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg. 2003;98(2):284\u2013290."},{"issue":"7","key":"b16","series-title":"Neurol Med Chir (Tokyo).","first-page":"545","article-title":"Hemorrhage rates associated with two methods of ventriculostomy: external ventricular drainage vs. ventriculoperitoneal shunt procedure","volume":"54","author":"Ko JK","year":"2014","unstructured":"Ko JK, Cha SH, Choi BK, Lee JI, Yun EY, Choi CH. Hemorrhage rates associated with two methods of ventriculostomy: external ventricular drainage vs. ventriculoperitoneal shunt procedure. Neurol Med Chir (Tokyo). 2014;54(7):545-551."},{"issue":"1","key":"b17","series-title":"Neurocrit Care","first-page":"23","article-title":"The incidence of catheter tract hemorrhage and catheter placement accuracy in the CLEAR III trial","volume":"29","author":"M\u00fcller A","year":"2018","unstructured":"M\u00fcller A, Mould WA, Freeman WD,  The incidence of catheter tract hemorrhage and catheter placement accuracy in the CLEAR III trial. Neurocrit Care. 2018;29(1):23\u201332."},{"issue":"4","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"755","article-title":"Accuracy and complication rates of external ventricular drain placement with twist drill and bolt system versus standard trephine and tunnelation: a retrospective population-based study","volume":"162","author":"Mansoor N","year":"2020","unstructured":"Mansoor N, Madsbu MA, Mansoor NM,  Accuracy and complication rates of external ventricular drain placement with twist drill and bolt system versus standard trephine and tunnelation: a retrospective population-based study. Acta Neurochir (Wien). 2020;162(4):755\u2013761."},{"issue":"2","key":"b19","series-title":"Neurocrit Care","first-page":"255","article-title":"Strategic placement of bedside ventriculostomies using ultrasound image guidance: report of three cases","volume":"17","author":"Phillips SB","year":"2012","unstructured":"Phillips SB, Gates M, Krishnamurthy S. Strategic placement of bedside ventriculostomies using ultrasound image guidance: report of three cases. Neurocrit Care. 2012;17(2):255\u2013259."},{"issue":"11","key":"b20","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1248","article-title":"Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients","volume":"80","author":"Farahmand D","year":"2009","unstructured":"Farahmand D, Hilmarsson H, H\u00f6gfeldt M, Tisell M. Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients. J Neurol Neurosurg Psychiatry. 2009;80(11):1248\u20131253."},{"issue":"7","key":"b21","series-title":"Acta Neurochir (Wien)","first-page":"1991","article-title":"CSF shunt valve occlusion\u2014does CSF protein and cell count matter?","volume":"163","author":"Kaestner S","year":"2021","unstructured":"Kaestner S, Sani R, Graf K, Uhl E, Godau J, Deinsberger W. CSF shunt valve occlusion\u2014does CSF protein and cell count matter?. Acta Neurochir (Wien). 2021;163(7):1991\u20131996."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/143\/1\/article-p127.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/143\/1\/article-p127.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/143\/1\/article-p127.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T14:27:23Z","timestamp":1772720843000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/143\/1\/article-p127.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":42,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2024.12.jns241625","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]}}}